Reduction of False Positive Haptic Inputs in a Robotic Surgical System

This application is a divisional of U.S. patent application Ser. No. 17/970,506, filed on Oct. 20, 2022, which claims the benefit of U.S. Provisional Application No. 63/270,557, filed on Oct. 21, 2021, entitled “Reduction of false Positive Haptic Inputs in a Robotic Surgical System,” each of which is hereby incorporated by reference in its entirety.

This application is related to U.S. patent application Ser. No. 17/970,505, filed on Oct. 20, 2022, issued as U.S. Pat. No. 12,484,983 on Dec. 2, 2025, entitled “Drift Detection of a Haptic Input Device in a Robotic Surgical System,” which is hereby incorporated by reference in its entirety.

The systems and methods disclosed herein are directed to input devices, and more particularly to input devices for robotic surgical systems.

A robotically enabled medical system is capable of performing a variety of medical procedures, including both minimally invasive procedures, such as laparoscopy, and non-invasive procedures, such as endoscopy (e.g., bronchoscopy, ureteroscopy, gastroscopy, etc.).

Such robotic medical systems may include robotic arms configured to control the movement of medical tool(s) during a given medical procedure. The robotic medical system may also include an input device used to control the positioning and/or actuation of the medical tool(s) during the medical procedure.

The systems, methods and devices of this disclosure each have several innovative aspects, no single one of which is solely responsible for the desirable attributes disclosed herein.

In one aspect, an input device for controlling a robotic surgical tool is provided. The input device can include a first pair of opposing links and a second pair of opposing links. The first pair of opposing links and the second pair of opposing links can be arranged radially symmetrically. The input device can be configured to control operation of the robotic surgical tool.

In some configurations, the first pair of opposing links is longer than the second pair of opposing links. The first pair of opposing links can be of equal length as the second pair of opposing links. Each of the first pair of opposing links can include a finger pad. Each of the second pair of opposing links can include a clutch button. The clutch button can be a push button. The clutch button can include a protruding ledge. The input device can include at least one clutch button. The at least one clutch button, when actuated, can be configured to decouple the input device from controlling operation of the robotic surgical tool. Each of the first pair of opposing links and each of the second pair of opposing links can be coupled to a central longitudinal member. The proximal ends of each of the first pair of opposing links and each of the second pair of opposing links can be configured to radially move relative to the central longitudinal member. Each of the first pair of opposing links can be configured to move together. Each of the second pair of opposing links can be configured to move together. The first pair of opposing links and the second pair of opposing can be are configured to move together. Each of the first pair of opposing links can be configured to move together, such that proximal ends of the first pair of opposing links are positioned equally distant from the central longitudinal member. The first pair of opposing links can be constrained to move together. The second pair of opposing links can be constrained to move together. The central longitudinal member can include a hall effect sensor.

In another aspect, an input device for controlling a robotic surgical tool can be provided. The input device can include a multi-link grasper comprising three or more links coupled to a central longitudinal member. The three or more links can be spaced less than 180 degrees from one another about the central longitudinal member. The multi-link grasper can be configured for controlling operation of the robotic surgical tool. The three or more links can be equally spaced from each other. Each of the three or more links can be configured to move from an open position where proximal ends of each of the three or more links are positioned radially away from the central longitudinal member to a closed position where the proximal ends of each of the three or more links are positioned radially close to the central longitudinal member. Each of the three or more links can be biased in the open position.

In yet another aspect, an input device for controlling a surgical tool can be provided. The input device can include a multi-link grasper comprising two or more links about a central longitudinal member for controlling operation of the surgical tool.

In some configurations, the at least one of the two or more links can include a finger input. The finger input can be capable of operating in a first mode and in a second mode. In the first mode, the finger input can operate as a finger clutch and, in the second mode, the finger clutch operates as a selecting tool. The finger input can include a push input. The finger input can include a rotary input. The central longitudinal member can include a sensor for detecting a mode of the finger input. The sensor can be coupled to the central longitudinal member. Each of the two or more links can include a curved face at a proximal end. The curved face can wrap around the central longitudinal member. The input device can include a rack gear. The rack gear can include gear teeth configured to mate with each of the two or more links. Each of the two or more links can be configured to rotate relative to the rack gear, wherein each of the two or more links are configured to engage with the rack gear such that rotation of one of the two or more links causes rotation of remaining links of the two or more links. Each of the two or more links can include bevel gear teeth configured to connect motion of each of the two or more links to the remainder of the two or more links.

In yet another aspect, a physician console can be provided. The physician console can include an input device including a first grasper and a second grasper. The input device can be configured to control a surgical tool. At least one of the first and second grasper can include a four-link radially symmetrical grasper for controlling operation of the surgical tool.

In accordance with some embodiments, an input device for controlling operation of a robotic arm is provided. The input device can include a first finger pad that includes a first set of two or more electrodes for determining a user presence at the first finger pad. The input device can also include a processor for modifying operation of the robotic arm in response to information from the input device in accordance with a determination of the user presence at the first finger pad.

In accordance with some embodiments, a method for operating a surgical tool via an input device is performed by one or more processors executing instructions store in memory. The method includes, while operating a robotic arm in response to information from an input device: (i) receiving first information from a first set of two or more electrodes, (ii) determining a user presence at a first finger pad based on the first information, and (iii) modifying operation of the robotic arm in response to the information from the input device in accordance with a determination of the user presence at the first finger pad. In some embodiments, modifying teleoperation of the robotic arm in response to the information from the input device may include any of: ceasing movement of the robotic arm in response to the information from the input device, reducing a velocity of the robotic arm in response to the information from the input device, or reducing motion scaling between the input device and the robotic arm.

In accordance with some embodiments, a medical system includes an input device for controlling operation of a robotic arm. The input device includes a grasper, the grasper includes a first finger pad, and the first finger pad includes two or more electrodes. The input device also includes an integrated circuit for measuring a mutual capacitance between the two or more electrodes of the first set of two or more electrodes for determining a user presence at the first finger pad.

In accordance with some embodiments, a medical system includes an input device for controlling a medical instrument. The input device includes a grasper for receiving user input and a sensor coupled to the grasper for generating sensor information related to a user presence at the grasper. The input device includes a processor and memory storing instructions for execution by the processor. The stored instructions include instructions for receiving secondary information associated with the grasper and determining a user presence at the grasper based on the sensor information and the secondary information.

In accordance with some embodiments, an input device for controlling operation of a robotic arm includes a grasper and a sensor coupled to the grasper for generating sensor information related to a user presence at the grasper. The input device also includes a processor and memory storing instructions for execution by the processor. The stored instructions include instructions for receiving secondary information from the input device, determining whether a user is in control of the input device based on the sensor information and the secondary information, and in accordance with a determination that the user is not in control of the input device, transitioning the medical system into a safe mode.

In accordance with some embodiments, a medical system includes an input device for controlling operation of a robotic arm. The input device includes a grasper and a sensor coupled to the grasper for generating sensor information related to a user presence at the grasper. The medical system also includes a processor and memory storing instructions for execution by the processor. The stored instructions include instructions for receiving secondary information from the input device, determining whether a user is in control of the input device based on the sensor information and the secondary information, and in accordance with a determination that the user is not in control of the input device, transitioning the medical system into a safe mode.

In accordance with some embodiments, a method for operating a medical system that includes an input device for controlling a medical instrument is performed by one or more processors executing instructions stored in memory. The method includes receiving, from a sensor coupled to a grasper of the input device, sensor information related to a user presence at the grasper. The method also includes receiving secondary information associated with the grasper and determining user control at the grasper based on the sensor information and the secondary information.

Note that the various embodiments described above can be combined with any other embodiments described herein. The features and advantages described in the specification are not all inclusive and, in particular, many additional features and advantages will be apparent to one of ordinary skill in the art in view of the drawings, specification, and claims. Moreover, it should be noted that the language used in the specification has been principally selected for readability and instructional purposes and may not have been selected to delineate or circumscribe the inventive subject matter.

Aspects of the present disclosure may be integrated into a robotically-enabled medical system capable of performing a variety of medical procedures, including both minimally invasive, such as laparoscopy, and non-invasive, such as endoscopy, procedures. Among endoscopic procedures, the system may be capable of performing bronchoscopy, ureteroscopy, gastroscopy, etc.

In addition to performing the breadth of procedures, the system may provide additional benefits, such as enhanced imaging and guidance to assist the physician. Additionally, the system may provide the physician with the ability to perform the procedure from an ergonomic position without the need for awkward arm motions and positions. Still further, the system may provide the physician with the ability to perform the procedure with improved ease of use such that one or more of the instruments of the system can be controlled by a single user.

Various embodiments will be described below in conjunction with the drawings for purposes of illustration. It should be appreciated that many other implementations of the disclosed concepts are possible, and various advantages can be achieved with the disclosed implementations. Headings are included herein for reference and to aid in locating various sections. These headings are not intended to limit the scope of the concepts described with respect thereto. Such concepts may have applicability throughout the entire specification.

1 FIG. 1 FIG. 2 FIG. 10 10 11 12 13 11 12 The robotically-enabled medical system may be configured in a variety of ways depending on the particular procedure.illustrates an embodiment of a cart-based robotically-enabled systemarranged for a diagnostic and/or therapeutic bronchoscopy. During a bronchoscopy, the systemmay comprise a carthaving one or more robotic armsto deliver a medical instrument, such as a steerable endoscope, which may be a procedure-specific bronchoscope for bronchoscopy, to a natural orifice access point (i.e., the mouth of the patient positioned on a table in the present example) to deliver diagnostic and/or therapeutic tools. As shown, the cartmay be positioned proximate to the patient's upper torso in order to provide access to the access point. Similarly, the robotic armsmay be actuated to position the bronchoscope relative to the access point. The arrangement inmay also be utilized when performing a gastro-intestinal (GI) procedure with a gastroscope, a specialized endoscope for GI procedures.depicts an example embodiment of the cart in greater detail.

1 FIG. 11 12 13 13 28 28 29 12 28 29 13 29 29 13 13 With continued reference to, once the cartis properly positioned, the robotic armsmay insert the steerable endoscopeinto the patient robotically, manually, or a combination thereof. As shown, the steerable endoscopemay comprise at least two telescoping parts, such as an inner leader portion and an outer sheath portion, each portion coupled to a separate instrument driver from the set of instrument drivers, each instrument driver coupled to the distal end of an individual robotic arm. This linear arrangement of the instrument drivers, which facilitates coaxially aligning the leader portion with the sheath portion, creates a “virtual rail”that may be repositioned in space by manipulating the one or more robotic armsinto different angles and/or positions. The virtual rails described herein are depicted in the Figures using dashed lines, and accordingly the dashed lines do not depict any physical structure of the system. Translation of the instrument driversalong the virtual railtelescopes the inner leader portion relative to the outer sheath portion or advances or retracts the endoscopefrom the patient. The angle of the virtual railmay be adjusted, translated, and pivoted based on clinical application or physician preference. For example, in bronchoscopy, the angle and position of the virtual railas shown represents a compromise between providing physician access to the endoscopewhile minimizing friction that results from bending the endoscopeinto the patient's mouth.

13 13 28 The endoscopemay be directed down the patient's trachea and lungs after insertion using precise commands from the robotic system until reaching the target destination or operative site. In order to enhance navigation through the patient's lung network and/or reach the desired target, the endoscopemay be manipulated to telescopically extend the inner leader portion from the outer sheath portion to obtain enhanced articulation and greater bend radius. The use of separate instrument driversalso allows the leader portion and sheath portion to be driven independently of each other.

13 13 13 For example, the endoscopemay be directed to deliver a biopsy needle to a target, such as, for example, a lesion or nodule within the lungs of a patient. The needle may be deployed down a working channel that runs the length of the endoscope to obtain a tissue sample to be analyzed by a pathologist. Depending on the pathology results, additional tools may be deployed down the working channel of the endoscope for additional biopsies. After identifying a nodule to be malignant, the endoscopemay endoscopically deliver tools to resect the potentially cancerous tissue. In some instances, diagnostic and therapeutic treatments can be delivered in separate procedures. In those circumstances, the endoscopemay also be used to deliver a fiducial to “mark” the location of the target nodule as well. In other instances, diagnostic and therapeutic treatments may be delivered during the same procedure.

10 30 11 11 30 11 30 11 30 The systemmay also include a movable tower, which may be connected via support cables to the cartto provide support for controls, electronics, fluidics, optics, sensors, and/or power to the cart. Placing such functionality in the towerallows for a smaller form factor cartthat may be more easily adjusted and/or re-positioned by an operating physician and his/her staff. Additionally, the division of functionality between the cart/table and the support towerreduces operating room clutter and facilitates improving clinical workflow. While the cartmay be positioned close to the patient, the towermay be stowed in a remote location to stay out of the way during a procedure.

30 30 11 In support of the robotic systems described above, the towermay include component(s) of a computer-based control system that stores computer program instructions, for example, within a non-transitory computer-readable storage medium such as a persistent magnetic storage drive, solid state drive, etc. The execution of those instructions, whether the execution occurs in the toweror the cart, may control the entire system or sub-system(s) thereof. For example, when executed by a processor of the computer system, the instructions may cause the components of the robotics system to actuate the relevant carriages and arm mounts, actuate the robotics arms, and control the medical instruments. For example, in response to receiving the control signal, the motors in the joints of the robotics arms may position the arms into a certain posture.

30 13 30 13 The towermay also include a pump, flow meter, valve control, and/or fluid access in order to provide controlled irrigation and aspiration capabilities to the system that may be deployed through the endoscope. These components may also be controlled using the computer system of the tower. In some embodiments, irrigation and aspiration capabilities may be delivered directly to the endoscopethrough separate cable(s).

30 11 11 11 The towermay include a voltage and surge protector designed to provide filtered and protected electrical power to the cart, thereby avoiding placement of a power transformer and other auxiliary power components in the cart, resulting in a smaller, more moveable cart.

30 10 30 10 30 30 30 The towermay also include support equipment for the sensors deployed throughout the robotic system. For example, the towermay include optoelectronics equipment for detecting, receiving, and processing data received from the optical sensors or cameras throughout the robotic system. In combination with the control system, such optoelectronics equipment may be used to generate real-time images for display in any number of consoles deployed throughout the system, including in the tower. Similarly, the towermay also include an electronic subsystem for receiving and processing signals received from deployed electromagnetic (EM) sensors. The towermay also be used to house and position an EM field generator for detection by EM sensors in or on the medical instrument.

30 31 31 10 13 31 10 30 30 The towermay also include a consolein addition to other consoles available in the rest of the system, e.g., console mounted on top of the cart. The consolemay include a user interface and a display screen, such as a touchscreen, for the physician operator. Consoles in the systemare generally designed to provide both robotic controls as well as preoperative and real-time information of the procedure, such as navigational and localization information of the endoscope. When the consoleis not the only console available to the physician, it may be used by a second operator, such as a nurse, to monitor the health or vitals of the patient and the operation of the system, as well as to provide procedure-specific data, such as navigational and localization information. In other embodiments, the consoleis housed in a body that is separate from the tower.

30 11 13 30 11 11 The towermay be coupled to the cartand endoscopethrough one or more cables or connections (not shown). In some embodiments, the support functionality from the towermay be provided through a single cable to the cart, simplifying and de-cluttering the operating room. In other embodiments, specific functionality may be coupled in separate cabling and connections. For example, while power may be provided through a single power cable to the cart, the support for controls, optics, fluidics, and/or navigation may be provided through a separate cable.

2 FIG. 1 FIG. 2 FIG. 11 11 14 15 16 14 14 17 12 17 12 17 19 17 14 provides a detailed illustration of an embodiment of the cartfrom the cart-based robotically-enabled system shown in. The cartgenerally includes an elongated support structure(often referred to as a “column”), a cart base, and a consoleat the top of the column. The columnmay include one or more carriages, such as a carriage(alternatively “arm support”) for supporting the deployment of one or more robotic arms(three shown in). The carriagemay include individually configurable arm mounts that rotate along a perpendicular axis to adjust the base of the robotic armsfor better positioning relative to the patient. The carriagealso includes a carriage interfacethat allows the carriageto vertically translate along the column.

19 14 20 14 17 20 17 15 17 11 12 17 21 12 The carriage interfaceis connected to the columnthrough slots, such as slot, that are positioned on opposite sides of the columnto guide the vertical translation of the carriage. The slotcontains a vertical translation interface to position and hold the carriageat various vertical heights relative to the cart base. Vertical translation of the carriageallows the cartto adjust the reach of the robotic armsto meet a variety of table heights, patient sizes, and physician preferences. Similarly, the individually configurable arm mounts on the carriageallow the robotic arm baseof the robotic armsto be angled in a variety of configurations.

20 14 17 20 17 17 17 17 19 17 In some embodiments, the slotmay be supplemented with slot covers that are flush and parallel to the slot surface to prevent dirt and fluid ingress into the internal chambers of the columnand the vertical translation interface as the carriagevertically translates. The slot covers may be deployed through pairs of spring spools positioned near the vertical top and bottom of the slot. The covers are coiled within the spools until deployed to extend and retract from their coiled state as the carriagevertically translates up and down. The spring-loading of the spools provides force to retract the cover into a spool when the carriagetranslates towards the spool, while also maintaining a tight seal when the carriagetranslates away from the spool. The covers may be connected to the carriageusing, for example, brackets in the carriage interfaceto ensure proper extension and retraction of the cover as the carriagetranslates.

14 17 16 The columnmay internally comprise mechanisms, such as gears and motors, that are designed to use a vertically aligned lead screw to translate the carriagein a mechanized fashion in response to control signals generated in response to user inputs, e.g., inputs from the console.

12 21 22 23 24 12 12 12 22 The robotic armsmay generally comprise robotic arm basesand end effectors, separated by a series of linkagesthat are connected by a series of joints, each joint comprising an independent actuator, each actuator comprising an independently controllable motor. Each independently controllable joint represents an independent degree of freedom available to the robotic arm. Each of the robotic armsmay have seven joints, and thus provide seven degrees of freedom. A multitude of joints result in a multitude of degrees of freedom, allowing for “redundant” degrees of freedom. Having redundant degrees of freedom allows the robotic armsto position their respective end effectorsat a specific position, orientation, and trajectory in space using different linkage positions and joint angles. This allows for the system to position and direct a medical instrument from a desired point in space while allowing the physician to move the arm joints into a clinically advantageous position away from the patient to create greater access, while avoiding arm collisions.

15 14 17 12 15 11 15 25 11 25 11 The cart basebalances the weight of the column, carriage, and robotic armsover the floor. Accordingly, the cart basehouses heavier components, such as electronics, motors, power supply, as well as components that either enable movement and/or immobilize the cart. For example, the cart baseincludes rollable wheel-shaped castersthat allow for the cartto easily move around the room prior to a procedure. After reaching the appropriate position, the castersmay be immobilized using wheel locks to hold the cartin place during the procedure.

14 16 26 26 16 16 14 17 16 12 16 11 16 27 11 Positioned at the vertical end of the column, the consoleallows for both a user interface for receiving user input and a display screen (or a dual-purpose device such as, for example, a touchscreen) to provide the physician user with both preoperative and intraoperative data. Potential preoperative data on the touchscreenmay include preoperative plans, navigation and mapping data derived from preoperative computerized tomography (CT) scans, and/or notes from preoperative patient interviews. Intraoperative data on display may include optical information provided from the tool, sensor and coordinate information from sensors, as well as vital patient statistics, such as respiration, heart rate, and/or pulse. The consolemay be positioned and tilted to allow a physician to access the consolefrom the side of the columnopposite the carriage. From this position, the physician may view the console, robotic arms, and patient while operating the consolefrom behind the cart. As shown, the consolealso includes a handleto assist with maneuvering and stabilizing the cart.

3 FIG. 10 11 32 32 11 12 32 12 32 33 illustrates an embodiment of a robotically-enabled systemarranged for ureteroscopy. In a ureteroscopic procedure, the cartmay be positioned to deliver a ureteroscope, a procedure-specific endoscope designed to traverse a patient's urethra and ureter, to the lower abdominal area of the patient. In a ureteroscopy, it may be desirable for the ureteroscopeto be directly aligned with the patient's urethra to reduce friction and forces on the sensitive anatomy in the area. As shown, the cartmay be aligned at the foot of the table to allow the robotic armsto position the ureteroscopefor direct linear access to the patient's urethra. From the foot of the table, the robotic armsmay insert the ureteroscopealong the virtual raildirectly into the patient's lower abdomen through the urethra.

32 32 32 32 After insertion into the urethra, using similar control techniques as in bronchoscopy, the ureteroscopemay be navigated into the bladder, ureters, and/or kidneys for diagnostic and/or therapeutic applications. For example, the ureteroscopemay be directed into the ureter and kidneys to break up kidney stone build up using a laser or ultrasonic lithotripsy device deployed down the working channel of the ureteroscope. After lithotripsy is complete, the resulting stone fragments may be removed using baskets deployed down the ureteroscope.

4 FIG. 10 10 11 34 11 12 35 34 28 illustrates an embodiment of a robotically-enabled systemsimilarly arranged for a vascular procedure. In a vascular procedure, the systemmay be configured such that the cartmay deliver a medical instrument, such as a steerable catheter, to an access point in the femoral artery in the patient's leg. The femoral artery presents both a larger diameter for navigation as well as a relatively less circuitous and tortuous path to the patient's heart, which simplifies navigation. As in a ureteroscopic procedure, the cartmay be positioned towards the patient's legs and lower abdomen to allow the robotic armsto provide a virtual railwith direct linear access to the femoral artery access point in the patient's thigh/hip region. After insertion into the artery, the medical instrumentmay be directed and inserted by translating the instrument drivers. Alternatively, the cart may be positioned around the patient's upper abdomen in order to reach alternative vascular access points, such as, for example, the carotid and brachial arteries near the shoulder and wrist.

5 FIG. 5 FIG. 36 37 38 39 36 42 40 41 42 38 Embodiments of the robotically-enabled medical system may also incorporate the patient's table. Incorporation of the table reduces the amount of capital equipment within the operating room by removing the cart, which allows greater access to the patient.illustrates an embodiment of such a robotically-enabled system arranged for a bronchoscopic procedure. Systemincludes a support structure or columnfor supporting platform(shown as a “table” or “bed”) over the floor. Much like in the cart-based systems, the end effectors of the robotic armsof the systemcomprise instrument driversthat are designed to manipulate an elongated medical instrument, such as a bronchoscopein, through or along a virtual railformed from the linear alignment of the instrument drivers. In practice, a C-arm for providing fluoroscopic imaging may be positioned over the patient's upper abdominal area by placing the emitter and detector around the table.

6 FIG. 36 37 43 36 39 43 44 37 39 43 37 37 39 38 43 37 43 37 43 36 36 39 39 provides an alternative view of the systemwithout the patient and medical instrument for discussion purposes. As shown, the columnmay include one or more carriagesshown as ring-shaped in the system, from which the one or more robotic armsmay be based. The carriagesmay translate along a vertical column interfacethat runs the length of the columnto provide different vantage points from which the robotic armsmay be positioned to reach the patient. The carriage(s)may rotate around the columnusing a mechanical motor positioned within the columnto allow the robotic armsto have access to multiples sides of the table, such as, for example, both sides of the patient. In embodiments with multiple carriages, the carriages may be individually positioned on the column and may translate and/or rotate independently of the other carriages. While the carriagesneed not surround the columnor even be circular, the ring-shape as shown facilitates rotation of the carriagesaround the columnwhile maintaining structural balance. Rotation and translation of the carriagesallows the systemto align the medical instruments, such as endoscopes and laparoscopes, into different access points on the patient. In other embodiments (not shown), the systemcan include a patient table or bed with adjustable arm supports in the form of bars or rails extending alongside it. One or more robotic arms(e.g., via a shoulder with an elbow joint) can be attached to the adjustable arm supports, which can be vertically adjusted. By providing vertical adjustment, the robotic armsare advantageously capable of being stowed compactly beneath the patient table or bed, and subsequently raised during a procedure.

39 43 45 39 45 43 43 45 38 38 38 6 FIG. 9 FIG. The robotic armsmay be mounted on the carriagesthrough a set of arm mountscomprising a series of joints that may individually rotate and/or telescopically extend to provide additional configurability to the robotic arms. Additionally, the arm mountsmay be positioned on the carriagessuch that, when the carriagesare appropriately rotated, the arm mountsmay be positioned on either the same side of the table(as shown in), on opposite sides of the table(as shown in), or on adjacent sides of the table(not shown).

37 38 43 37 43 37 43 39 The columnstructurally provides support for the table, and a path for vertical translation of the carriages. Internally, the columnmay be equipped with lead screws for guiding vertical translation of the carriages, and motors to mechanize the translation of the carriagesbased the lead screws. The columnmay also convey power and control signals to the carriagesand the robotic armsmounted thereon.

46 15 11 38 37 43 39 46 46 46 36 2 FIG. The table baseserves a similar function as the cart basein the cartshown in, housing heavier components to balance the table/bed, the column, the carriages, and the robotic arms. The table basemay also incorporate rigid casters to provide stability during procedures. Deployed from the bottom of the table base, the casters may extend in opposite directions on both sides of the baseand retract when the systemneeds to be moved.

6 FIG. 36 36 46 39 With continued reference to, the systemmay also include a tower (not shown) that divides the functionality of the systembetween the table and the tower to reduce the form factor and bulk of the table. As in earlier disclosed embodiments, the tower may provide a variety of support functionalities to the table, such as processing, computing, and control capabilities, power, fluidics, and/or optical and sensor processing. The tower may also be movable to be positioned away from the patient to improve physician access and de-clutter the operating room. Additionally, placing components in the tower allows for more storage space in the table basefor potential stowage of the robotic arms. The tower may also include a master controller or console that provides both a user interface for user input, such as keyboard and/or pendant, as well as a display screen (or touchscreen) for preoperative and intraoperative information, such as real-time imaging, navigation, and tracking information. In some embodiments, the tower may also contain holders for gas tanks to be used for insufflation.

7 FIG. 47 47 48 49 50 51 48 49 52 48 51 50 53 52 54 In some embodiments, a table base may stow and store the robotic arms when not in use.illustrates a systemthat stows robotic arms in an embodiment of the table-based system. In the system, carriagesmay be vertically translated into baseto stow robotic arms, arm mounts, and the carriageswithin the base. Base coversmay be translated and retracted open to deploy the carriages, arm mounts, and robotic armsaround column, and closed to stow to protect them when not in use. The base coversmay be sealed with a membranealong the edges of its opening to prevent dirt and fluid ingress when closed.

8 FIG. 38 55 37 46 55 55 37 55 38 35 37 39 56 57 58 55 38 illustrates an embodiment of a robotically-enabled table-based system configured for a ureteroscopic procedure. In a ureteroscopy, the tablemay include a swivel portionfor positioning a patient off-angle from the columnand table base. The swivel portionmay rotate or pivot around a pivot point (e.g., located below the patient's head) in order to position the bottom portion of the swivel portionaway from the column. For example, the pivoting of the swivel portionallows a C-arm (not shown) to be positioned over the patient's lower abdomen without competing for space with the column (not shown) below table. By rotating the carriage(not shown) around the column, the robotic armsmay directly insert a ureteroscopealong a virtual railinto the patient's groin area to reach the urethra. In a ureteroscopy, stirrupsmay also be fixed to the swivel portionof the tableto support the position of the patient's legs during the procedure and allow clear access to the patient's groin area.

9 FIG. 9 FIG. 43 36 39 38 59 45 In a laparoscopic procedure, through small incision(s) in the patient's abdominal wall, minimally invasive instruments may be inserted into the patient's anatomy. In some embodiments, the minimally invasive instruments comprise an elongated rigid member, such as a shaft, which is used to access anatomy within the patient. After inflation of the patient's abdominal cavity, the instruments may be directed to perform surgical or medical tasks, such as grasping, cutting, ablating, suturing, etc. In some embodiments, the instruments can comprise a scope, such as a laparoscope.illustrates an embodiment of a robotically-enabled table-based system configured for a laparoscopic procedure. As shown in, the carriagesof the systemmay be rotated and vertically adjusted to position pairs of the robotic armson opposite sides of the table, such that instrumentmay be positioned using the arm mountsto be passed through minimal incisions on both sides of the patient to reach his/her abdominal cavity.

10 FIG. 10 FIG. 36 38 45 39 38 37 60 37 38 46 To accommodate laparoscopic procedures, the robotically-enabled table system may also tilt the platform to a desired angle.illustrates an embodiment of the robotically-enabled medical system with pitch or tilt adjustment. As shown in, the systemmay accommodate tilt of the tableto position one portion of the table at a greater distance from the floor than the other. Additionally, the arm mountsmay rotate to match the tilt such that the robotic armsmaintain the same planar relationship with the table. To accommodate steeper angles, the columnmay also include telescoping portionsthat allow vertical extension of the columnto keep the tablefrom touching the floor or colliding with the table base.

11 FIG. 38 37 61 38 37 61 1 2 3 4 5 1 6 2 38 37 provides a detailed illustration of the interface between the tableand the column. Pitch rotation mechanismmay be configured to alter the pitch angle of the tablerelative to the columnin multiple degrees of freedom. The pitch rotation mechanismmay be enabled by the positioning of orthogonal axes,at the column-table interface, each axis actuated by a separate motor,responsive to an electrical pitch angle command. Rotation along one screwwould enable tilt adjustments in one axis, while rotation along the other screwwould enable tilt adjustments along the other axis. In some embodiments, a ball joint can be used to alter the pitch angle of the tablerelative to the columnin multiple degrees of freedom.

For example, pitch adjustments are particularly useful when trying to position the table in a Trendelenburg position, i.e., position the patient's lower abdomen at a higher position from the floor than the patient's upper abdomen, for lower abdominal surgery. The Trendelenburg position causes the patient's internal organs to slide towards his/her upper abdomen through the force of gravity, clearing out the abdominal cavity for minimally invasive tools to enter and perform lower abdominal surgical or medical procedures, such as laparoscopic prostatectomy.

12 13 FIGS.and 14 FIG. 100 100 105 101 105 101 105 101 105 101 105 101 105 100 105 101 105 101 105 101 illustrate isometric and end views of an alternative embodiment of a table-based surgical robotics system. The surgical robotics systemincludes one or more adjustable arm supportsthat can be configured to support one or more robotic arms (see, for example,) relative to a table. In the illustrated embodiment, a single adjustable arm supportis shown, though an additional arm support can be provided on an opposite side of the table. The adjustable arm supportcan be configured so that it can move relative to the tableto adjust and/or vary the position of the adjustable arm supportand/or any robotic arms mounted thereto relative to the table. For example, the adjustable arm supportmay be adjusted one or more degrees of freedom relative to the table. The adjustable arm supportprovides high versatility to the system, including the ability to easily stow the one or more adjustable arm supportsand any robotics arms attached thereto beneath the table. The adjustable arm supportcan be elevated from the stowed position to a position below an upper surface of the table. In other embodiments, the adjustable arm supportcan be elevated from the stowed position to a position above an upper surface of the table.

105 105 105 105 109 102 101 105 105 105 105 101 105 105 12 13 FIGS.and 12 FIG. The adjustable arm supportcan provide several degrees of freedom, including lift, lateral translation, tilt, etc. In the illustrated embodiment of, the arm supportis configured with four degrees of freedom, which are illustrated with arrows in. A first degree of freedom allows for adjustment of the adjustable arm supportin the z-direction (“Z-lift”). For example, the adjustable arm supportcan include a carriageconfigured to move up or down along or relative to a columnsupporting the table. A second degree of freedom can allow the adjustable arm supportto tilt. For example, the adjustable arm supportcan include a rotary joint, which can allow the adjustable arm supportto be aligned with the bed in a Trendelenburg position. A third degree of freedom can allow the adjustable arm supportto “pivot up,” which can be used to adjust a distance between a side of the tableand the adjustable arm support. A fourth degree of freedom can permit translation of the adjustable arm supportalong a longitudinal length of the table.

100 102 103 103 102 101 131 133 12 13 FIGS.and 13 FIG. The surgical robotics systemincan comprise a table supported by a columnthat is mounted to a base. The baseand the columnsupport the tablerelative to a support surface. A floor axisand a support axisare shown in.

105 102 105 101 103 105 109 111 107 107 The adjustable arm supportcan be mounted to the column. In other embodiments, the arm supportcan be mounted to the tableor base. The adjustable arm supportcan include a carriage, a bar or rail connectorand a bar or rail. In some embodiments, one or more robotic arms mounted to the railcan translate and move relative to one another.

109 102 113 109 102 123 113 105 105 115 105 105 117 105 119 117 107 111 127 105 121 105 129 13 FIG. The carriagecan be attached to the columnby a first joint, which allows the carriageto move relative to the column(e.g., such as up and down a first or vertical axis). The first jointcan provide the first degree of freedom (“Z-lift”) to the adjustable arm support. The adjustable arm supportcan include a second joint, which provides the second degree of freedom (tilt) for the adjustable arm support. The adjustable arm supportcan include a third joint, which can provide the third degree of freedom (“pivot up”) for the adjustable arm support. An additional joint(shown in) can be provided that mechanically constrains the third jointto maintain an orientation of the railas the rail connectoris rotated about a third axis. The adjustable arm supportcan include a fourth joint, which can provide a fourth degree of freedom (translation) for the adjustable arm supportalong a fourth axis.

14 FIG. 140 105 105 101 142 107 105 142 144 107 142 146 142 144 107 142 146 146 illustrates an end view of the surgical robotics systemA with two adjustable arm supportsA,B mounted on opposite sides of a table. A first robotic armA is attached to the bar or railA of the first adjustable arm supportB. The first robotic armA includes a baseA attached to the railA. The distal end of the first robotic armA includes an instrument drive mechanismA that can attach to one or more robotic medical instruments or tools. Similarly, the second robotic armB includes a baseB attached to the railB. The distal end of the second robotic armB includes an instrument drive mechanismB. The instrument drive mechanismB can be configured to attach to one or more robotic medical instruments or tools.

142 142 142 142 144 144 142 142 In some embodiments, one or more of the robotic armsA,B comprises an arm with seven or more degrees of freedom. In some embodiments, one or more of the robotic armsA,B can include eight degrees of freedom, including an insertion axis (1-degree of freedom including insertion), a wrist (3-degrees of freedom including wrist pitch, yaw and roll), an elbow (1-degree of freedom including elbow pitch), a shoulder (2-degrees of freedom including shoulder pitch and yaw), and baseA,B (1-degree of freedom including translation). In some embodiments, the insertion degree of freedom can be provided by the robotic armA,B, while in other embodiments, the instrument itself provides insertion via an instrument-based insertion architecture.

The end effectors of the system's robotic arms may comprise (i) an instrument driver (alternatively referred to as “instrument drive mechanism” or “instrument device manipulator”) that incorporates electro-mechanical means for actuating the medical instrument and (ii) a removable or detachable medical instrument, which may be devoid of any electro-mechanical components, such as motors. This dichotomy may be driven by the need to sterilize medical instruments used in medical procedures, and the inability to adequately sterilize expensive capital equipment due to their intricate mechanical assemblies and sensitive electronics. Accordingly, the medical instruments may be designed to be detached, removed, and interchanged from the instrument driver (and thus the system) for individual sterilization or disposal by the physician or the physician's staff. In contrast, the instrument drivers need not be changed or sterilized, and may be draped for protection.

15 FIG. 15 FIG. 62 63 64 63 64 65 66 67 68 63 62 68 66 67 illustrates an example instrument driver. Positioned at the distal end of a robotic arm, instrument drivercomprises one or more drive unitsarranged with parallel axes to provide controlled torque to a medical instrument via drive shafts. Each drive unitcomprises an individual drive shaftfor interacting with the instrument, a gear headfor converting the motor shaft rotation to a desired torque, a motorfor generating the drive torque, an encoderto measure the speed of the motor shaft and provide feedback to the control circuitry, and control circuityfor receiving control signals and actuating the drive unit. Each drive unitbeing independently controlled and motorized, the instrument drivermay provide multiple (e.g., four as shown in) independent drive outputs to the medical instrument. In operation, the control circuitrywould receive a control signal, transmit a motor signal to the motor, compare the resulting motor speed as measured by the encoderwith the desired speed, and modulate the motor signal to generate the desired torque.

For procedures that require a sterile environment, the robotic system may incorporate a drive interface, such as a sterile adapter connected to a sterile drape, that sits between the instrument driver and the medical instrument. The chief purpose of the sterile adapter is to transfer angular motion from the drive shafts of the instrument driver to the drive inputs of the instrument while maintaining physical separation, and thus sterility, between the drive shafts and drive inputs. Accordingly, an example sterile adapter may comprise a series of rotational inputs and outputs intended to be mated with the drive shafts of the instrument driver and drive inputs on the instrument. Connected to the sterile adapter, the sterile drape, comprised of a thin, flexible material such as transparent or translucent plastic, is designed to cover the capital equipment, such as the instrument driver, robotic arm, and cart (in a cart-based system) or table (in a table-based system). Use of the drape would allow the capital equipment to be positioned proximate to the patient while still being located in an area not requiring sterilization (i.e., non-sterile field). On the other side of the sterile drape, the medical instrument may interface with the patient in an area requiring sterilization (i.e., sterile field).

16 FIG. 70 71 72 72 73 74 75 76 73 72 74 75 74 73 74 73 illustrates an example medical instrument with a paired instrument driver. Like other instruments designed for use with a robotic system, medical instrumentcomprises an elongated shaft(or elongate body) and an instrument base. The instrument base, also referred to as an “instrument handle” due to its intended design for manual interaction by the physician, may generally comprise rotatable drive inputs, e.g., receptacles, pulleys or spools, that are designed to be mated with drive outputsthat extend through a drive interface on instrument driverat the distal end of robotic arm. When physically connected, latched, and/or coupled, the mated drive inputsof the instrument basemay share axes of rotation with the drive outputsin the instrument driverto allow the transfer of torque from the drive outputsto the drive inputs. In some embodiments, the drive outputsmay comprise splines that are designed to mate with receptacles on the drive inputs.

71 71 74 75 74 75 The elongated shaftis designed to be delivered through either an anatomical opening or lumen, e.g., as in endoscopy, or a minimally invasive incision, e.g., as in laparoscopy. The elongated shaftmay be either flexible (e.g., having properties similar to an endoscope) or rigid (e.g., having properties similar to a laparoscope) or contain a customized combination of both flexible and rigid portions. When designed for laparoscopy, the distal end of a rigid elongated shaft may be connected to an end effector extending from a jointed wrist formed from a clevis with at least one degree of freedom and a surgical tool or medical instrument, such as, for example, a grasper or scissors, that may be actuated based on force from the tendons as the drive inputs rotate in response to torque received from the drive outputsof the instrument driver. When designed for endoscopy, the distal end of a flexible elongated shaft may include a steerable or controllable bending section that may be articulated and bent based on torque received from the drive outputsof the instrument driver.

75 71 71 73 72 72 71 71 73 71 Torque from the instrument driveris transmitted down the elongated shaftusing tendons along the elongated shaft. These individual tendons, such as pull wires, may be individually anchored to individual drive inputswithin the instrument handle. From the handle, the tendons are directed down one or more pull lumens along the elongated shaftand anchored at the distal portion of the elongated shaft, or in the wrist at the distal portion of the elongated shaft. During a surgical procedure, such as a laparoscopic, endoscopic or hybrid procedure, these tendons may be coupled to a distally mounted end effector, such as a wrist, grasper, or scissor. Under such an arrangement, torque exerted on drive inputswould transfer tension to the tendon, thereby causing the end effector to actuate in some way. In some embodiments, during a surgical procedure, the tendon may cause a joint to rotate about an axis, thereby causing the end effector to move in one direction or another. Alternatively, the tendon may be connected to one or more jaws of a grasper at the distal end of the elongated shaft, where tension from the tendon causes the grasper to close.

71 73 71 In endoscopy, the tendons may be coupled to a bending or articulating section positioned along the elongated shaft(e.g., at the distal end) via adhesive, control ring, or other mechanical fixation. When fixedly attached to the distal end of a bending section, torque exerted on the drive inputswould be transmitted down the tendons, causing the softer, bending section (sometimes referred to as the articulable section or region) to bend or articulate. Along the non-bending sections, it may be advantageous to spiral or helix the individual pull lumens that direct the individual tendons along (or inside) the walls of the endoscope shaft to balance the radial forces that result from tension in the pull wires. The angle of the spiraling and/or spacing therebetween may be altered or engineered for specific purposes, wherein tighter spiraling exhibits lesser shaft compression under load forces, while lower amounts of spiraling results in greater shaft compression under load forces, but limits bending. On the other end of the spectrum, the pull lumens may be directed parallel to the longitudinal axis of the elongated shaftto allow for controlled articulation in the desired bending or articulable sections.

71 71 71 71 71 71 In endoscopy, the elongated shafthouses a number of components to assist with the robotic procedure. The shaftmay comprise a working channel for deploying surgical tools (or medical instruments), irrigation, and/or aspiration to the operative region at the distal end of the shaft. The shaftmay also accommodate wires and/or optical fibers to transfer signals to/from an optical assembly at the distal tip, which may include an optical camera. The shaftmay also accommodate optical fibers to carry light from proximally-located light sources, such as light emitting diodes, to the distal end of the shaft.

70 At the distal end of the instrument, the distal tip may also comprise the opening of a working channel for delivering tools for diagnostic and/or therapy, irrigation, and aspiration to an operative site. The distal tip may also include a port for a camera, such as a fiberscope or a digital camera, to capture images of an internal anatomical space. Relatedly, the distal tip may also include ports for light sources for illuminating the anatomical space when using the camera.

16 FIG. 71 71 71 73 73 71 71 In the example of, the drive shaft axes, and thus the drive input axes, are orthogonal to the axis of the elongated shaft. This arrangement, however, complicates roll capabilities for the elongated shaft. Rolling the elongated shaftalong its axis while keeping the drive inputsstatic results in undesirable tangling of the tendons as they extend off the drive inputsand enter pull lumens within the elongated shaft. The resulting entanglement of such tendons may disrupt any control algorithms intended to predict movement of the flexible elongated shaftduring an endoscopic procedure.

17 FIG. 80 81 82 81 83 80 83 83 83 84 80 84 80 83 83 84 83 80 81 85 illustrates an alternative design for an instrument driver and instrument where the axes of the drive units are parallel to the axis of the elongated shaft of the instrument. As shown, a circular instrument drivercomprises four drive units with their drive outputsaligned in parallel at the end of a robotic arm. The drive units, and their respective drive outputs, are housed in a rotational assemblyof the instrument driverthat is driven by one of the drive units within the assembly. In response to torque provided by the rotational drive unit, the rotational assemblyrotates along a circular bearing that connects the rotational assemblyto the non-rotational portionof the instrument driver. Power and controls signals may be communicated from the non-rotational portionof the instrument driverto the rotational assemblythrough electrical contacts that may be maintained through rotation by a brushed slip ring connection (not shown). In other embodiments, the rotational assemblymay be responsive to a separate drive unit that is integrated into the non-rotatable portion, and thus not in parallel to the other drive units. The rotational mechanismallows the instrument driverto rotate the drive units, and their respective drive outputs, as a single unit around an instrument driver axis.

86 88 87 89 81 80 88 87 89 16 FIG. Like earlier disclosed embodiments, an instrumentmay comprise an elongated shaft portionand an instrument base(shown with a transparent external skin for discussion purposes) comprising a plurality of drive inputs(such as receptacles, pulleys, and spools) that are configured to receive the drive outputsin the instrument driver. Unlike prior disclosed embodiments, the instrument shaftextends from the center of the instrument basewith an axis substantially parallel to the axes of the drive inputs, rather than orthogonal as in the design of.

83 80 86 87 88 83 85 88 87 88 85 83 88 87 88 89 87 81 89 88 When coupled to the rotational assemblyof the instrument driver, the medical instrument, comprising instrument baseand instrument shaft, rotates in combination with the rotational assemblyabout the instrument driver axis. Since the instrument shaftis positioned at the center of instrument base, the instrument shaftis coaxial with instrument driver axiswhen attached. Thus, rotation of the rotational assemblycauses the instrument shaftto rotate about its own longitudinal axis. Moreover, as the instrument baserotates with the instrument shaft, any tendons connected to the drive inputsin the instrument baseare not tangled during rotation. Accordingly, the parallelism of the axes of the drive outputs, drive inputs, and instrument shaftallows for the shaft rotation without tangling any control tendons.

18 FIG. 150 150 152 162 152 170 152 152 154 156 152 158 158 180 180 152 180 152 180 162 illustrates an instrument having an instrument based insertion architecture in accordance with some embodiments. The instrumentcan be coupled to any of the instrument drivers discussed above. The instrumentcomprises an elongated shaft, an end effectorconnected to the shaft, and a handlecoupled to the shaft. The elongated shaftcomprises a tubular member having a proximal portionand a distal portion. The elongated shaftcomprises one or more channels or groovesalong its outer surface. The groovesare configured to receive one or more wires or cablestherethrough. One or more cablesthus run along an outer surface of the elongated shaft. In other embodiments, cablescan also run through the elongated shaft. Manipulation of the one or more cables(e.g., via an instrument driver) results in actuation of the end effector.

170 172 174 The instrument handle, which may also be referred to as an instrument base, may generally comprise an attachment interfacehaving one or more mechanical inputs, e.g., receptacles, pulleys or spools, that are designed to be reciprocally mated with one or more torque couplers on an attachment surface of an instrument driver.

150 152 170 150 150 In some embodiments, the instrumentcomprises a series of pulleys or cables that enable the elongated shaftto translate relative to the handle. In other words, the instrumentitself comprises an instrument-based insertion architecture that accommodates insertion of the instrument, thereby minimizing the reliance on a robot arm to provide insertion of the instrument. In other embodiments, a robotic arm can be largely responsible for instrument insertion.

Any of the robotic systems described herein can include an input device or controller for manipulating an instrument attached to a robotic arm. In some embodiments, the controller can be coupled (e.g., communicatively, electronically, electrically, wirelessly and/or mechanically) with an instrument such that manipulation of the controller causes a corresponding manipulation of the instrument e.g., via master slave control.

19 FIG. 182 182 182 182 182 is a perspective view of an embodiment of a controller. In the present embodiment, the controllercomprises a hybrid controller that can have both impedance and admittance control. In other embodiments, the controllercan utilize just impedance or passive control. In other embodiments, the controllercan utilize just admittance control. By being a hybrid controller, the controlleradvantageously can have a lower perceived inertia while in use.

182 184 184 186 186 188 In the illustrated embodiment, the controlleris configured to allow manipulation of two medical instruments, and includes two handles. Each of the handlesis connected to a gimbal. Each gimbalis connected to a positioning platform.

19 FIG. 188 198 194 196 196 194 197 184 198 184 As shown in, each positioning platformincludes a SCARA arm (selective compliance assembly robot arm)coupled to a columnby a prismatic joint. The prismatic jointsare configured to translate along the column(e.g., along rails) to allow each of the handlesto be translated in the z-direction, providing a first degree of freedom. The SCARA armis configured to allow motion of the handlein an x-y plane, providing two additional degrees of freedom.

186 182 188 186 186 188 188 186 In some embodiments, one or more load cells are positioned in the controller. For example, in some embodiments, a load cell (not shown) is positioned in the body of each of the gimbals. By providing a load cell, portions of the controllerare capable of operating under admittance control, thereby advantageously reducing the perceived inertia of the controller while in use. In some embodiments, the positioning platformis configured for admittance control, while the gimbalis configured for impedance control. In other embodiments, the gimbalis configured for admittance control, while the positioning platformis configured for impedance control. Accordingly, for some embodiments, the translational or positional degrees of freedom of the positioning platformcan rely on admittance control, while the rotational degrees of freedom of the gimbalrely on impedance control.

Traditional endoscopy may involve the use of fluoroscopy (e.g., as may be delivered through a C-arm) and other forms of radiation-based imaging modalities to provide endoluminal guidance to an operator physician. In contrast, the robotic systems contemplated by this disclosure can provide for non-radiation-based navigational and localization means to reduce physician exposure to radiation and reduce the amount of equipment within the operating room. As used herein, the term “localization” may refer to determining and/or monitoring the position of objects in a reference coordinate system. Technologies such as preoperative mapping, computer vision, real-time EM tracking, and robot command data may be used individually or in combination to achieve a radiation-free operating environment. In other cases, where radiation-based imaging modalities are still used, the preoperative mapping, computer vision, real-time EM tracking, and robot command data may be used individually or in combination to improve upon the information obtained solely through radiation-based imaging modalities.

20 FIG. 1 FIG. 1 4 FIGS.- 5 14 FIGS.- 90 90 30 11 is a block diagram illustrating a localization systemthat estimates a location of one or more elements of the robotic system, such as the location of the instrument, in accordance to an example embodiment. The localization systemmay be a set of one or more computer devices configured to execute one or more instructions. The computer devices may be embodied by a processor (or processors) and computer-readable memory in one or more components discussed above. By way of example and not limitation, the computer devices may be in the towershown in, the cartshown in, the beds shown in, etc.

20 FIG. 90 95 91 94 96 96 As shown in, the localization systemmay include a localization modulethat processes input data-to generate location datafor the distal tip of a medical instrument. The location datamay be data or logic that represents a location and/or orientation of the distal end of the instrument relative to a frame of reference. The frame of reference can be a frame of reference relative to the anatomy of the patient or to a known object, such as an EM field generator (see discussion below for the EM field generator).

91 94 91 The various input data-are now described in greater detail. Preoperative mapping may be accomplished through the use of the collection of low dose CT scans. Preoperative CT scans are reconstructed into three-dimensional images, which are visualized, e.g. as “slices” of a cutaway view of the patient's internal anatomy. When analyzed in the aggregate, image-based models for anatomical cavities, spaces and structures of the patient's anatomy, such as a patient lung network, may be generated. Techniques such as center-line geometry may be determined and approximated from the CT images to develop a three-dimensional volume of the patient's anatomy, referred to as model data(also referred to as “preoperative model data” when generated using only preoperative CT scans). The use of center-line geometry is discussed in U.S. patent application Ser. No. 14/523,760, issued as U.S. Pat. No. 9,763,741 on Sep. 19, 2017, the contents of which are herein incorporated in its entirety. Network topological models may also be derived from the CT-images, and are particularly appropriate for bronchoscopy.

92 95 92 91 92 91 In some embodiments, the instrument may be equipped with a camera to provide vision data (or image data). The localization modulemay process the vision datato enable one or more vision-based (or image-based) location tracking modules or features. For example, the preoperative model datamay be used in conjunction with the vision datato enable computer vision-based tracking of the medical instrument (e.g., an endoscope or an instrument advance through a working channel of the endoscope). For example, using the preoperative model data, the robotic system may generate a library of expected endoscopic images from the model based on the expected path of travel of the endoscope, each image linked to a location within the model. Intraoperatively, this library may be referenced by the robotic system in order to compare real-time images captured at the camera (e.g., a camera at a distal end of the endoscope) to those in the image library to assist localization.

95 91 Other computer vision-based tracking techniques use feature tracking to determine motion of the camera, and thus the endoscope. Some features of the localization modulemay identify circular geometries in the preoperative model datathat correspond to anatomical lumens and track the change of those geometries to determine which anatomical lumen was selected, as well as the relative rotational and/or translational motion of the camera. Use of a topological map may further enhance vision-based algorithms or techniques.

92 Optical flow, another computer vision-based technique, may analyze the displacement and translation of image pixels in a video sequence in the vision datato infer camera movement. Examples of optical flow techniques may include motion detection, object segmentation calculations, luminance, motion compensated encoding, stereo disparity measurement, etc. Through the comparison of multiple frames over multiple iterations, movement and location of the camera (and thus the endoscope) may be determined.

95 93 The localization modulemay use real-time EM tracking to generate a real-time location of the endoscope in a global coordinate system that may be registered to the patient's anatomy, represented by the preoperative model. In EM tracking, an EM sensor (or tracker) comprising one or more sensor coils embedded in one or more locations and orientations in a medical instrument (e.g., an endoscopic tool) measures the variation in the EM field created by one or more static EM field generators positioned at a known location. The location information detected by the EM sensors is stored as EM data. The EM field generator (or transmitter), may be placed close to the patient to create a low intensity magnetic field that the embedded sensor may detect. The magnetic field induces small currents in the sensor coils of the EM sensor, which may be analyzed to determine the distance and angle between the EM sensor and the EM field generator. These distances and orientations may be intraoperatively “registered” to the patient anatomy (e.g., the preoperative model) in order to determine the geometric transformation that aligns a single location in the coordinate system with a position in the preoperative model of the patient's anatomy. Once registered, an embedded EM tracker in one or more positions of the medical instrument (e.g., the distal tip of an endoscope) may provide real-time indications of the progression of the medical instrument through the patient's anatomy.

94 95 96 Robotic command and kinematics datamay also be used by the localization moduleto provide localization datafor the robotic system. Device pitch and yaw resulting from articulation commands may be determined during preoperative calibration. Intraoperatively, these calibration measurements may be used in combination with known insertion depth information to estimate the position of the instrument. Alternatively, these calculations may be analyzed in combination with EM, vision, and/or topological modeling to estimate the position of the medical instrument within the network.

20 FIG. 20 FIG. 95 95 Asshows, a number of other input data can be used by the localization module. For example, although not shown in, an instrument utilizing shape-sensing fiber can provide shape data that the localization modulecan use to determine the location and shape of the instrument.

95 91 94 95 91 94 93 95 92 94 The localization modulemay use the input data-in combination(s). In some cases, such a combination may use a probabilistic approach where the localization moduleassigns a confidence weight to the location determined from each of the input data-. Thus, where the EM data may not be reliable (as may be the case where there is EM interference) the confidence of the location determined by the EM datacan be decrease and the localization modulemay rely more heavily on the vision dataand/or the robotic command and kinematics data.

As discussed above, the robotic systems discussed herein may be designed to incorporate a combination of one or more of the technologies above. The robotic system's computer-based control system, based in the tower, bed and/or cart, may store computer program instructions, for example, within a non-transitory computer-readable storage medium such as a persistent magnetic storage drive, solid state drive, or the like, that, upon execution, cause the system to receive and analyze sensor data and user commands, generate control signals throughout the system, and display the navigational and localization data, such as the position of the instrument within the global coordinate system, anatomical map, etc.

Embodiments of the disclosure relate to systems and techniques for input devices for operating robotic medical systems and/or one or more medical instruments with such robotic medical systems.

Robotic medical systems, such as the systems described above, can include an input device that is configured to allow an operator (e.g., a physician performing a robotically-enabled medical procedure) to manipulate and control one or more instruments. In some embodiments, the robotic medical system can include an input device for operating one or more medical tools. In some examples, the input device can operate one or more medical tools remotely, such as via teleoperation or telesurgery.

One skilled in the art will appreciate that the input devices described herein can be applied in non-medical contexts as well. For example, the input devices can be useful for manipulating tools that involve hazardous substances. In addition, in some embodiments, the input devices described herein can be useful in grabbing objects in both physical and virtual environments. In some configurations, the input devices can be self-sufficient as service robots interacting with human operators. In some configurations, the input device can be coupled (e.g., communicatively, electronically, electrically, wirelessly and/or mechanically) with a medical instrument such that manipulation of the input device causes a corresponding manipulation of the medical instrument. In some configurations, the input device and the medical instrument are arranged in a master-slave pair. In some configurations, the input device can be configured to control operation of a robotic surgical tool. In some configurations, the input device can be referred to as a manipulator, emulator, master, controller, interface, etc.

The input device can serve as an input for an operator to control the actions of a medical instrument, such as in an endoscopic, endoluminal, laparoscopic, or open surgery. Movement of the input device by the operator can direct the movement of the medical instrument. For example, when an operator translates the input device in three-dimensional space (e.g., up, down, left, right, backwards, forwards), the system can cause a corresponding translation of the medical instrument. Similarly, if the operator rotates the input device (e.g., around any of three orthogonal axes) the system can cause a corresponding rotational movement of the medical instrument. The input device can also include one or more inputs that allow the operator to actuate the medical instrument. As one example, if the medical instrument includes a grasper instrument, the input device can include one or more inputs that allow the operator to open and close the grasper instrument.

In some embodiments, robotic medical systems include input devices with seven degrees of freedom that follow the operator's hand movement, with the seven degrees of freedom including three positional degrees of freedom (e.g., translational movement in x, y, z space), three rotational degrees of freedom (e.g., rotational movement around pitch, roll, and yaw axes), and one (or more) instrument actuation degree of freedom (e.g., an angular degree of freedom). In some embodiments, the instrument actuation degree of freedom can control the opening and closing of an end effector of the medical instrument, such as a gripper or grasper instrument to hold an object. In some embodiments, input devices can include greater or fewer numbers of degrees of freedom. For example, in some embodiments, the input device can include more than three positional degrees of freedom or more than three rotational degrees of freedom to provide one or more redundant degrees of freedom. In some embodiments, redundant degrees of freedom can provide additional mechanical flexibility for the input device, for example, to avoid singularities caused by the mechanical structure of the input device.

19 FIG. 182 184 184 186 184 shows an embodiment of an input device or controllerthat can be used by a user to control one or more instruments. As noted above, the controller can include two handlesthat can be used to control instrumentation. Each of the handlescan be connected to a gimbal. Both of the handlescan serve as a grasper.

The grasper can be the portion of the input device that the operator (e.g., a physician, a user, etc.) touches and holds to allow the operator to control the components of the robotic system, such as the medical instruments. The grasper can be the operator's primary input into the system during surgery.

21 21 FIGS.A-B 19 FIG. 200 illustrate an embodiment of a handle or grasperthat can be used as part of a input system such as the input system described above with reference to.

21 FIG.A 21 FIG.B 22 FIG. 21 21 FIGS.A-B 200 200 200 200 202 204 206 208 200 200 200 illustrates the grasperin an open configuration, whileillustrates the grasperin a closed configuration.illustrates the grasper ofin an exploded view. The graspercan include a plurality of links and in the illustrated embodiment the grasperincludes four links,,,. In some configurations, the grasper can include at least two links. In some configurations, the graspercan include at least three links. In some examples, the graspercan have any number of links, such as anywhere between 2-12 links. In some embodiments, the plurality of links can be arranged circumferentially around the grasper. In some configurations, the plurality of links can be equally spaced from one another. In some configurations, the plurality of links can be spaced less than 180 degrees from one another about a central axis. Although the configurations described below include four links, any number of links can be included.

21 21 FIGS.A-B 200 202 204 206 208 202 204 206 208 200 202 204 206 208 202 204 206 208 202 204 206 208 202 204 206 208 200 As illustrated in, the grasperincludes four links comprising a first link, a second link, a third link, and a fourth link. The four links,,,can be spaced about the circumference of the grasper. The four links,,,can be spaced evenly from each other. The four links can be arranged radially symmetrically. In some embodiments, the four links,,,can each be spaced less than 180 degrees from the adjacent links. The four links,,,may be each spaced approximately 90 degrees from one another as shown in the illustrated arrangement. The plurality of links,,,can be arranged circumferentially about the grasperas illustrated.

202 204 206 208 200 202 204 206 208 202 204 206 208 202 204 206 208 The links,,,can be arranged in pairs. For example, the graspercan include a first pair of opposing links,and a second pair of opposing links,. In the illustrated arrangement, the first pair of opposing links can include the first linkand the second linkspaced approximately 180 degrees from one another. In the illustrated arrangement, the second pair of opposing links can include the third linkand the fourth linkspaced approximately 180 degrees from one another. In modified arrangements, the links,of the first pair of opposing links can be spaced less than 180 degrees from each the links,of the second pair of opposing links.

22 FIG. 200 250 250 300 200 300 250 With reference to, the graspercan include a central shaft. The central shaftcan be called a longitudinal shaft, longitudinal member, central member, shaft, or member. The central shaft can include a circuit, such as a printed circuit board, to connect to other components of the grasperor other components of the robotic system. In the illustrated arrangement, the circuitcan be placed inside the central shaft.

250 202 204 206 208 202 204 206 208 250 202 232 222 204 234 224 206 236 226 208 238 228 202 204 206 208 232 234 236 238 222 224 226 228 The central shaftcan support the plurality of links,,,. Each of the first pair of opposing links,and each of the second pair of opposing links,can be coupled to the central shaft. The first linkcan have a proximal endand a distal end. The second linkcan have a proximal endand a distal end. The third linkcan have a proximal endand a distal end. The fourth linkcan have a proximal endand a distal end. The plurality of links,,,can be connected or operatively connected at their respective proximal ends,,,and/or at their respective distal ends,,,.

202 204 212 214 206 208 216 218 202 204 206 208 242 244 246 248 232 234 236 238 202 204 206 208 250 The first pair of opposing links,can each include a finger grip or pad,. The second pair of opposing links,can each include a secondary input,. Each of the plurality of links,,,, can include a secondary link,,,to attach the proximal ends,,,of the links,,,to the central shaft.

232 234 236 238 202 204 206 208 250 232 234 236 238 202 204 206 208 250 200 232 234 236 238 202 204 206 208 250 200 202 204 206 208 200 222 224 226 228 250 232 234 236 238 202 204 206 208 250 21 FIG.A Each of the plurality of links can be configured to move from an open position where proximal ends,,,of each of the plurality of links,,,are positioned radially away from the central shaftto a closed position where the proximal ends,,,of each of the plurality of links,,,are positioned radially close to the central shaft. With reference again to, the grasperis shown in an open position with the proximal ends,,,of the plurality of links,,,positioned away from the central shaftof the grasper. Each of the plurality of links,,,can be connected to the grasperat each of its respective distal ends,,,, such that each link can extend or pivot at an angle away from a central shaft. The proximal ends,,,of each of the first pair of opposing links,and each of the second pair of opposing links,are configured to radially move relative to the central shaft.

21 FIG.B 200 232 234 236 238 202 204 206 208 250 200 232 234 236 238 250 202 204 206 208 250 With reference again to, the grasperis shown in a closed position with the proximal ends,,,of the plurality of links,,,positioned close to the central shaftof the grasper. In the closed position, each of the proximal ends,,,can be positioned close to the central shaft, such that the each of plurality of links,,,can be parallel in length to the central shaft.

202 204 206 208 Each of the plurality of links,,,can be biased in an open position. In some configurations, each link can be spring-loaded in an open position. In some configurations, there are at least two springs (not shown) for each link with a first spring providing the majority of the force to bias the link in an open position. A second spring can provide a slight haptic feedback when the link reaches a certain degree of closure to indicates to the user when the grasper is closed and that further motion to close the grasper will result in an increase of clamping force of the surgical instrument.

202 204 206 208 202 204 For example, the first pair of opposing links,and/or the second pair of opposing links,can be maneuvered in a pinching motion, which can be translated to movement of the surgical instrument inside the body. For example, opening and closing the first pair of opposing links,would correspond to opening and closing of a scissor tool or jaws of a medical instrument. The facilitated pinching motion can make grasper actuation natural and easy for the user.

202 204 206 208 200 202 204 206 208 250 The plurality of links,,,on the graspercan measure the input angle of the user's fingers. For example, the angle at which any one or more of the plurality of links,,,are positioned relative to the central shaftcan be translated to the desired angle of a component of the instrument, such as one or more jaws of an end effector of the instrument.

200 200 21 21 22 FIGS.A-B and The graspercan have an increased number of links (such as four links as shown in) and/or links that are positioned closer to each other. The graspercan also be radially symmetrical, in particular at the most distal end.

By having such a radially symmetric configuration of the grasper, a user can advantageously be capable of performing certain movements with ease (e.g., a roll maneuver) that would otherwise be challenging. If a user wants to do a roll-intensive task (e.g., suturing) with agrasper unlike those described herein, the user can only rotate the grasper approximately 180 degrees before their wrist runs out of range of motion without repositioning the user's hand. To continue rolling the grasper, they have to release their current position of the grasper, rotate their wrist and regrip the grasper to continue.

The radially symmetric grasper with the plurality of links spaced less than 180 degrees from each other allows the physician to roll the grasper between their finger-tips while maintaining the desired orientation of the grasper (such as in the closed position or in maintaining the closure angle). This is possible since the user's fingers always make contact with at least two links because of the increased number of plurality of links and reduction of the dead zones that can exist between the plurality of links.

212 214 202 204 206 208 222 224 226 228 202 24 206 208 200 212 214 212 214 222 224 226 228 202 204 206 208 200 200 202 204 206 208 200 200 200 202 204 206 208 222 224 226 228 202 204 206 208 200 Some users may choose to work outside of the finger pads,, to hold the plurality of links,,,closer to their distal ends,,,of the plurality of links,,,. The grasperadvantageously is able to accommodate this and allow for comfortable use both in and out of the finger pads,. Additionally, when working outside of the finger pads,(such as at the distal ends,,,of one or more of the plurality of links,,,), the graspercan have radial symmetry, such that the physician can close the grasper(such as closing the first pair of opposing links,and/or closing the second pair of opposing links,) and then roll the grasperbetween their fingers. When executing this roll maneuver of the grasper, it can be desirable to have the grasperremain in the closed position. The first pair of opposing links,and/or the second pair of opposing links,can be identical and symmetrical at their distal ends,,,, allowing the user to use any of the plurality of links,,,to close the grasper.

200 200 212 214 200 200 200 The radial symmetry at the distal end can advantageously be more forgiving of misalignment of the user's hand when operating the grasper. Furthermore, the increased number of links being spaced closely together (such as, less than 180 degrees from one another) allows the user to more easily position their fingers to maintain contact with one or more of the plurality of links as they maneuver the grasper. For example, when working outside the finger pads,, the user can use any combination of the plurality of links to actuate the grasper. The plurality of links can increase the number of points of contacts for a user to actuate the grasper. This can allow the user to maintain contact with the actuators of the grasper more easily, to decrease difficultly of positioning and readjusting of the user's hand. The plurality of links and radial symmetry can give a user more freedom to manipulate the grasper.

202 204 206 208 202 204 206 208 202 204 202 204 212 214 The first pair of opposing links,can be longer in length than the second pair of opposing links,. The plurality of links can be arranged such that the longer links,oppose each other, with the shorter links,located between the two. The two longer links,can serve as the main grasping links. The longer links,can have finger grips, pads, loops such as the finger pads,of the illustrated arrangement.

202 204 206 208 206 208 202 204 In other examples, the first pair of opposing links,and the second pair of opposing links,can be of equal length. In other examples, the second pair of opposing links,can be longer in length than the first pair of opposing links,.

23 FIG. 21 21 22 FIGS.A-B and 24 FIG.A 250 260 250 260 260 202 204 206 208 250 260 202 204 206 208 250 202 204 206 208 250 250 260 260 260 illustrates the grasper ofwithout the plurality of links, to show the central support shaftand a sliding supportin more detail. The main support shaftcan serve as a bearing surface for the sliding support. The slide or a sliding supportcan be connect to the plurality of links,,,as shown in. The main support shaftcan engage with or connect to the sliding supportto constrain of links,,,relative to the central support shaftwhile still allowing translation of the rotation of the plurality of links,,,relative to the central support shaft. For example, the central support shaftcan have slots or recesses to receive portions of the sliding supportor receive keys that connect to the sliding support. Additionally, the keys can serve as stops to limit the translation of the sliding support. In some examples, the limit of translation can be approximately 5 mm.

24 24 FIGS.A andB 24 FIG.A 24 FIG.B 24 FIG.A 24 FIG.B 206 208 202 204 202 204 202 204 232 234 260 202 204 206 208 260 242 244 242 244 202 204 260 250 260 200 242 246 202 204 250 260 242 244 250 232 234 236 238 250 260 250 202 204 242 248 250 260 202 204 242 244 250 202 204 202 204 202 204 202 204 232 234 202 204 250 illustrate the grasper without the second pair of links,for clarity.illustrates the grasper with the first pair of links,in the open position.illustrates the grasper with the first pair of links,in the closed position. As illustrated, the first pair of links,can be connected at their respective proximal ends,to the sliding support. For example, each of the plurality of links,,,can be connected to the sliding supportwith secondary links,, respectively. The secondary links,, can be free to pivot to change an angular displacement of the respective link,into an axial translation of the sliding supportalong the central shaft. In the open position as shown in, the sliding supportcan be positioned towards the proximal end of the grasper, such that the secondary links,and the first pair of links,are each angled away from the central shaft. As the sliding supportis moved in a distal direction, the secondary links,are angled farther away from the central shaft, which in turn moves the proximal ends,,,away from the central shaft. In the closed position as shown in, the sliding supportcan be positioned more proximally along the central shaft, such that the first pair of links,and the secondary links,are extended and angularly positioned closer to the central shaft. In the open position, the sliding supportcan be positioned such that the first pair of links,and/or the secondary links,are fully extended in length and substantially parallel to the central support. In this configuration, axial displacement in one of the links,causes the same displacement in the other link,. In this configuration, the motion of the first pair of links,are constrained together. Each of the first pair of opposing links,can be configured to move together, such that proximal ends,of the first pair of opposing links,are positioned equally distant from the central shaft.

202 204 206 208 202 204 206 208 202 204 206 208 In some of the configurations, the first pair of opposing links,are configured to move together. In some configurations, the second pair of opposing links,are configured to move together. In some of the configurations, the first pair of opposing links,and the second pair of opposing links,are configured to move together. In some of the configurations, the first pair of opposing links,and the second pair of opposing links,are configured to move independently. In some configurations, each of the plurality of links is configured to move independently. In some configurations, each of the plurality of links is configured to move together.

24 24 FIG.A-B 206 208 236 238 260 246 248 202 204 206 208 260 202 204 206 208 202 204 206 208 202 204 206 208 Although not shown infor clarity, the second pair of links,can similarly be connected at their respective proximal ends,can be connected to the sliding supportwith secondary links,, respectively. In the illustrated arrangement, all four links,,,can be connected to the same sliding support. In this configuration, axial displacement in one of the plurality of links,,,causes the same displacement in the remaining three of the plurality of links,,,. In this configuration, the motion of the plurality of links,,,are constrained together.

200 262 262 250 262 250 250 262 260 262 260 202 204 206 208 202 204 206 208 242 244 246 248 262 The graspercan include a proximal plate. The proximal platecan be attached to or integral with the central support shaft. The proximal platecan be positioned about the central support shafttowards the proximal end of the central support shaft. The proximal platecan act as a stop to limit axial translation of the sliding support. In some examples, the proximal platecan be positioned to prevent the sliding supportfrom extending the plurality of links,,,past the lengths of the plurality of links,,,and/or the secondary links,,,. In some examples, the proximal platecan also serve as an additional surface to support the user's hand.

202 204 206 208 222 224 226 228 202 204 206 208 222 224 226 228 270 202 204 206 208 232 234 236 238 The plurality of links,,,can be connected or operatively connected at their respective distal ends,,,. For example, the plurality of links,,,can be connected or operatively connected at their respective distal ends,,,to the distal link support. The plurality of links,,,can be connected or operatively connected at their respective proximal ends,,,.

25 FIG.A 25 FIG.B 25 FIG.A 25 25 FIGS.A-B 202 212 202 212 202 202 204 204 214 202 204 212 214 212 214 202 204 212 214 202 204 212 214 202 204 illustrates a top view of a first linkwith a finger pad.illustrates a bottom view of the first linkwith the finger padof. Although only the first linkof the first pair of links,is shown in, the second linkand figure padcan be substantially similar. The first pair of opposing links,can each include a finger pad,, respectively. The finger pads,can facilitate manipulation of the finger links,by increasing the surface area by which the user can contact and maneuver the opposing links. The finger pads,can be attached to the respective links,by bolts. A Velcro loop (not shown) can be positioned between the finger pads,and the respective links,to secure around a user's finger when in use.

202 204 223 243 222 224 202 204 223 243 202 204 223 243 200 223 243 200 212 214 The first pair of links,can each include a distal ridge,located at the distal ends,of the first pair of links,, The distal ridges,can each follow the contour of the respective link,. The distal ridges,can be ergonomic features that allows the physician to easily grip and maneuver the grasperat the distal end. For example, the distal ridges,can act as a surface to enable a user to pull the graspertowards them when working outside the finger pads,.

202 204 302 304 202 204 302 202 202 250 302 304 202 204 302 304 202 204 250 206 208 25 FIG.B The first pair of links,can each include a magnet,used to sense the position of the respective pair of links,. As shown in, a magnetcan be positioned or mounted on the bottom of the link. Angular displacements of the linkcan be sensed by a hall effect sensor. The hall effect sensor can be positioned on or in the central shaft. The hall effect sensor can be used to measure the magnitude or changes in the magnetic field. As the plurality of links changes angles, the one or more sensors can be used to detect the change in magnetic field due to the motion of the magnets,, which occurs through motion of the respective links,. In some configurations, the hall effect sensor can be used to detect the distance of the magnet,and thus the links,with respect to the central shaft, which can be used by the input device to transmit control signals. Similarly, the second pair of links,can also each include a magnet. Additionally, other sensors can be used, such as resistance sensors and/or optical sensors.

200 As described above, as the user maneuvers the plurality of links of the grasper, the user's fingers can adjust the angle of the plurality of links. The plurality of links can be oriented or angled relative to the central axis or central shaft. The plurality of links on the grasper can measure the input angle of the user's fingers. For example, the angle at which any one or more of the plurality of links are positioned relative to the central shaft can be translated to the desired angle of a component of the instrument, such as one or more jaws of an end effector of the instrument. The graspercan include one or more sensors to measure the angle of the plurality of links and thus the input angle of the user's fingers. Also described above, the secondary input state can also be measured by one or more sensors.

The grasper can include one or more sensors in various locations. In some configurations, one or more sensors can be located in or coupled to one or more of the plurality of links. In some configurations, one or more sensors can be located in or coupled to the central shaft. The one or more sensors in the central shaft can be advantageous in that there is limited space on each of the plurality of links. The one or more sensors in the central shaft can also advantageously position the sensor away from motion of the links and from contact by the user, which can reduce risk of damaging the sensor.

In some configurations, the one or more sensors can include a hall effect sensor, such as a 3D hall effect sensor. The one or more sensors can include 3 different sensors in orthogonal orientations to each other. Using these sensor readings, an algorithm can be developed to determine both the angle of the plurality of links and detect a secondary input state. The position of the one or more sensors in the central shaft can also advantageously remove the need to run wires and package sensors on the links.

The one or more sensors can detect one or more magnets included in the plurality of link and/or one or more magnets in a secondary input. For example, each link can include one or more magnets in fixed locations. As the plurality of links changes angles, the one or more sensors can be used to detect the change in magnetic field due to the motion of these magnets.

Similarly, the secondary input can include or be operatively connected to one or more magnets, such that change or movement in the secondary input can change the position or orientation of the one or more magnets, which can be detected by the sensor. In some examples, the change of the magnetic field due to the secondary input can be coupled with the motion of the grasper or with one or more components of the grasper. In some examples, the angle of the plurality of links can be decoupled from the secondary input state.

In some configurations, the one or more sensors can be a 3 degrees-of-freedom sensor with physical electrical connections to the plurality of links and secondary inputs.

In some instances, the input device (e.g., the grasper) may not always be under the control of the operator. In addition, the input device may receive an input that is not intended by the user (e.g., unintended motion), which may be caused by the user or some other personnel in the operating room applying a disturbance to the input device or from gravity compensation errors (e.g., a user overcompensating for the gravity). In these instances, there may be a need to modify teleoperation and suppress or reduce movement of the robotic arms and its associated instruments. By detecting the unintended motion, the robotic system can respond to the user input to modify teleoperation and reduce, suppress, or stop movement of the robotic arms and associated instruments.

29 29 FIGS.A andB 21 FIG.A 200 illustrate a sensor at the grasperoffor sensing a user presence in accordance with some embodiments.

29 FIG.A 200 310 310 212 310 214 200 211 206 213 208 213 310 213 310 As shown in, the grasperincludes one or more sensorsthat are configured to generate a signal in response to a user being in proximity to the sensor. In some embodiments, a first sensor of the one or more sensorsis embedded in the finger pad. In some embodiments, the one or more sensorsinclude a second sensor that is embedded in the finger pad. In some embodiments, the grasperalso includes a finger padthat is part of opposing linkand a finger padthat is part of opposing link. The finger padmay include a third sensor of the one or more sensors, and the finger padmay include a fourth sensor of the one or more sensors.

29 FIG.B 34 FIG.A 310 311 311 328 In some embodiments, as shown in, a sensor of the one or more sensorsincludes one or more electrodes(e.g., a metallic electrode and/or a conductive electrode). In some embodiments, the one or more electrodesare connected to an integrated circuit (e.g., integrated circuitshown in). The integrated circuit is configured to measure a capacitance that changes when a user's body part (such as a user's hand, finger, or palm) is in proximity to the one or more electrodes. In some embodiments, the sensor includes the integrated circuit. In some embodiments, the integrated circuit is separate from the sensor (although the integrated circuit is electrically connected to the sensor).

310 310 311 300 311 311 311 300 392 394 311 306 30 FIG.A In some embodiments, at least one sensor (e.g., sensor) of the one or more sensorsincludes one electrode(only), and the integrated circuit includes circuitfor measuring a self-capacitance of the electrode(e.g., the capacitance between the electrodeand the earth), as shown in. The self-capacitance changes when a user's body part is in proximity to the electrode. In some embodiments, the circuitincludes an excitation signal source(e.g., an oscillator or an alternating current source) and an analog-to-digital convertercoupled to the (same) electrodevia a multiplexer.

310 310 311 1 311 2 301 311 1 311 2 311 1 311 2 311 1 311 2 301 392 311 1 394 311 2 30 30 FIGS.B andC 30 30 FIGS.B andC In some embodiments, at least one sensor (e.g., sensor) of the one or more sensorsincludes two or more electrodes-and-, and the integrated circuit includes circuitfor measuring a mutual-capacitance between the two electrodes-and-, as illustrated in. As shown in, the mutual-capacitance changes when a user's body part is in proximity to the electrode-or-, or between the two electrodes-and-. In some embodiments, the circuitincludes the excitation signal source(e.g., an oscillator or an alternating current source) coupled to a first electrode of the two or more electrodes (e.g., the electrode-) and the analog-to-digital convertercoupled to a second electrode of the two or more electrodes (e.g., the electrode-) that is distinct from the first electrode.

30 FIG.D 314 311 202 204 206 208 200 250 200 311 310 314 200 250 200 311 311 illustrates that, in some configurations, a sensor may detect a change in capacitance due to placement of a user's body part in proximity to components(e.g., a metallic component) located adjacently to one or more electrodesof the sensor. In addition, since the links,,, andof grasperare movable with respect to a the central supportof the grasper, the distance between the one or more electrodesof a sensorand other componentsof the grasper, such as the central supportand other components disposed on the central support, may change during operation of the grasper. Thus, even when the user's body part is not in proximity to the one or more electrodes, the capacitance can change, which can be interpreted incorrectly to indicate that the user's body part is in proximity to the one or more electrodes.

30 FIG.E 310 310 311 312 311 314 200 312 310 311 310 314 200 311 310 314 200 312 314 200 311 illustrates that, in some embodiments, at least one sensor (e.g., sensor) of the one or more sensorsincludes an electrode layer that includes the one or more electrodes, and a shield layerfor reducing capacitance between the one or more electrodesand componentsof the grasper. The shield layerof the sensoris disposed between the one or more electrodesof the sensorand other componentsof the grasper. This reduces (and ideally, eliminates) changes in the measured capacitance due to a change in position of the one or more electrodesof the sensorrelative to a position of the other componentsof the grasper. Thus, the shield layerreduces the effect that the other componentsof the graspercan have on the capacitance measured by the sensor with the one or more electrodes.

31 FIG. 29 29 FIGS.A andB 310 311 312 310 309 312 309 311 1 311 2 311 1 311 2 312 312 311 1 311 2 312 311 312 310 200 312 250 200 309 250 200 illustrates an example of the sensorshown inthat includes an electrode layerand a shield layer. In this example, the sensorincludes the electrode layerand the shield layer. The electrode layerincludes a first electrode-that is surrounded by a second electrode-. In some embodiments, the electrodes-and-are insulated from the shield layer(e.g., the shield layermay include a conductive material and the electrodes-and-are insulated from the shield layerto reduce (and ideally, prevent or eliminate) any conductive effects between the electrodesand the shield layer). In some embodiments, the sensoris positioned in the grasperwith the shield layerfacing toward inward (e.g., toward the central supportof the grasper) and the electrode layerfacing outward (e.g., away from the central supportof the grasper).

310 313 310 328 In some embodiments, the sensorincludes an extension, which is used for electrically connecting the sensorto an integrated circuit (e.g., the integrated circuit).

310 310 310 310 310 310 310 313 310 29 FIG.A In some embodiments, the sensoris made flexible (e.g., the sensoris made of a flexible material). For example, the sensorincludes a multi-layer flex circuit. In some embodiments, the flex circuit is embedded in the finger pad (e.g.,). In some embodiments, the flex circuit is formed, molded, or machined into the finger pad. For example, in some embodiments, the flex circuit is injection molded in the finger pad. In some embodiments, the entire sensoris made flexible. In some embodiments, only a portion of the sensoris made flexible (e.g., a first portion of the sensoris rigid while a second portion of the sensoris flexible). For example, in some embodiments, the extensionis flexible, while the rest of the sensor(called herein a sensing portion) is rigid.

32 32 FIGS.A andB 29 FIG.A 32 FIG.A 32 FIG.B 311 311 1 311 2 311 311 311 1 311 2 311 illustrate examples of electrode configurations for the sensor shown in.illustrates an electrode configuration-A that includes a first electrode-that is interleaved with a second electrode-. In some implementations, the electrode configuration-A provides consistent sensitivity across its surface area.illustrates another electrode configuration-B that includes the first electrode-being disposed side-by-side to the second electrode-. In some implementations, the electrode configuration-B provides electrodes with large surface areas, thereby providing high sensitivity.

33 FIG. 29 29 FIGS.A andB 33 FIG. 318 311 1 311 2 310 311 1 311 2 318 316 311 1 311 2 311 1 311 2 310 318 322 324 322 322 322 316 320 320 311 1 311 2 illustrates an example measurement for sensing a user presence using the sensor shown in.illustrates an example graph showing a signalcorresponding to a measured capacitance between two electrodes-and-of a sensorover time in response to a user's body part changing its distance to the electrodes-and-. As shown, the signalincreases from a baseline value(e.g., a background capacitance value when a user's body part is not proximate to the electrodes-and-) in response to a user's body part approaching the electrodes-and-of the sensor. The signalincreases above a detection threshold valueuntil it reaches a maximum capacitance value. The detection threshold valuecorresponds a capacitance value above which a user presence is deemed to be present. In some embodiments, the detection threshold valueis selected in a way so that the difference between the detection threshold valueand the baseline valueis greater than a representative value of noise(e.g., 3, 4, 5, 6, 7, 8, 9, or 10 times greater than a root-mean-squared amplitude of the noisedetected by the electrodes-and-).

318 328 318 320 In some embodiments, the signalis processed (e.g., by the integrated circuit) before determining the user presence. For example, the signalis filtered to remove or reduce the noise(e.g., based on the rate of change by using, for example, a frequency domain filter, such as a Fourier filter or a derivative integral filter).

34 FIG.A 29 29 FIGS.A andB 328 330 313 328 328 200 illustrates coupling of the sensor shown into an integrated circuitfor sensing a user presence. The sensor includes a flexible connector(corresponding to the extension) for electrical connection to the integrated circuit. This allows the relative movement (e.g., a rotational movement) of the sensing portion of the sensor to the integrated circuitwhile maintaining the electrical contact between the sensing portion of the sensor to the integrated circuit, which may be located at the tip of the grasper.

200 328 330 200 328 330 330 330 211 214 328 34 FIG.B In some embodiments, each finger pad of the grasperincludes a sensor and the sensor of each finger pad is electrically coupled to the integrated circuitthrough the flexible connector. For example, when the grasperincludes four finger pads (and hence at least four sensors), the integrated circuitis electrically coupled to the four sensors via four flexible connectors(e.g., one flexible connectorfor each sensor).illustrates four flexible connectorselectrically coupling the four sensors embedded in the four finger padsthroughto the integrated circuit.

35 35 FIGS.A andB 21 FIG.A illustrate examples of light curtain configurations generated by optical sensors located at the input device offor sensing a user presence.

35 FIG.A 35 FIG.A 200 332 334 334 1 334 3 334 334 334 1 334 3 336 1 33 6 334 334 334 334 200 332 200 334 334 In, the grasper, mounted on a gimbal, is coupled with one or more optical sensors(e.g., optical sensors-through-). The one or more optical sensorsdetect optical signals from a user's body part to determine the user presence. In some embodiments, the one or more optical sensorsare coupled with, or include, a light source for providing illumination light and the one or more optical sensors detect light that has been reflected or scattered by the user's body part, such as finger(s). In some embodiments, each of the one or more optical sensors-through-is coupled with, or includes, a light source for providing light curtains-through-, respectively. In some embodiments, the one or more optical sensorsinclude a time-of-flight sensor for determining a distance from the time-of-flight sensor to an object (e.g., the user's body part) that comes into a corresponding light curtain. In some embodiments, each of the one or more optical sensorsis a time-of-flight sensor. In some embodiments, the one or more optical sensorsinclude other types of optical sensors (e.g., beam break sensors, LIDAR, cameras, etc.). In some embodiments, the one or more optical sensorsare amounted adjacent to one end of the graspertoward the gimbaltoward to the opposite end of the grasper, as shown in. This configuration allows placing the one or more optical sensorsso that fingers are placed within the field of view of the one or more optical sensors.

35 FIG.B 334 334 1 334 2 332 200 200 332 334 1 334 2 334 334 3 200 200 332 In, at least a subset of the one or more optical sensors(e.g., the optical sensors-and-) is mounted on the gimbalfacing toward the grasper(e.g., the one end of the grasperthat is not directly coupled to the gimbal). In some embodiments, the optical sensors-and-are placed to avoid occlusion by the finger pads. In some embodiments, the one or more optical sensorsalso include at least one optical sensor-mounted on the one end of the grasper(facing away from the opposite end of the graspercoupled to the gimbal). This optical sensor may be used to detect a presence of a user's palm, which can provide additional information for determining the user presence.

35 35 FIGS.A andB Althoughshow three optical sensors, in some embodiments, additional or fewer optical sensors may be used (e.g., 1, 2, 4, 5, 6, 7, 8, 9, 10, or more optical sensors).

35 35 FIGS.A andB In addition, althoughare used to describe placement of optical sensors, other types of sensors (e.g., ultrasonic sensors, radar, sonar, pressure sensors, etc.) may be used instead of, or in addition to, the optical sensors.

36 36 FIGS.A andB 21 FIG.A 36 FIG.A 36 FIG.B 338 1 338 2 340 1 340 2 338 328 340 340 illustrate examples of finger loops for use in conjunction with optical sensors at the input device of.shows finger loops-and-(with open ends) andshows finger loops-and-(with closed ends, in which case the finger loops may be called finger cups). The finger loopsprovide a secure connection between the user and the grasper. In some embodiments, the integrated circuitis configured to distinguish the finger loops from the user's body parts (e.g., using threshold windows to differentiate signals from the user's body parts and signals from the finger loops). In some implementations, the wall of the finger cupsfacilitate distinguishing the user's body parts from the finger cups.

200 200 200 36 36 FIGS.A andB As described herein, the sensors (e.g., capacitance sensors, optical sensors, etc.) are used to determine the user presence, which can be used to reduce or eliminate unintended movements of the robotic arms or surgical tools. It is also helpful to determine the user control even when the user contact is not detected on the grasper. For example, when the user uses the finger loops or finger cups (shown in) to control the grasper (e.g., during the opening of the grasper), the user is still in control of the grasper, although the user may not be in contact with (or in proximity to) the sensors within the finger pads as the fingers are lifted away from the finger pads.

In some embodiments, user control is determined by combining, information from the one or more sensors described above (e.g., capacitance sensors and/or optical sensors) with additional information (also called herein secondary information). In some embodiments, the movement of the robotic arms or surgical tools is controlled based on the information from the one or more sensors (e.g., capacitance sensors and/or optical sensors) and the secondary information, thereby enhancing operation of medical robotic systems.

202 24 FIG.A In some embodiments, the additional information includes a grasper angle (e.g., an angle defined by the central axis of the grasper and a link, such as link). In some configurations, the grasper is at a fully-open angle (e.g., as shown in) when no external force is applied (e.g., no user input). Thus, a grasper angle other than, or less than, a predefined grasper angle threshold (e.g., the fully-open angle) indicates that the user is in control.

37 FIG. 21 FIG.A 37 FIG. 342 200 200 200 200 342 200 342 344 200 344 200 200 344 200 344 In some embodiments, the additional information includes a velocity or movement of one or more joints supporting the input device.illustrates robotic joints supporting the input device ofin accordance with some embodiments. For example, as shown in, a gimbal roll axisextends through a roll joint that is rotatably coupled with the grasperalong the axis of the grasper. The roll joint is designed to have passively zero velocity (e.g., there is no gravity compensation), so there cannot be any gravity compensation error. As such, it has no movement (and hence, zero velocity) when there is no user input to the grasper(e.g., when the user is not operating the grasper). Thus, a rotational movement (or a rotational velocity) of the rolling joint along the gimbal roll axisindicates that the user is in control (e.g., the user is rotating the grasperabout the gimbal roll axis). In another example, a rotational joint extending through a shoulder yaw axisis coupled to the grasper. The rotational joint extending through the shoulder yaw axishas no movement (and hence, zero velocity) when there is no user input to the grasper(e.g., when the user is not operating the grasper). Thus, a rotational movement (or a rotational velocity) of the rotational joint extending through the shoulder yaw axiscan also indicate that the user is in control (e.g., the user is moving the grasperabout the shoulder yaw axis).

In some embodiments, the additional information includes a time period or duration from the most recent detection of user presence. By providing a time duration as an additional input, the system can advantageously account for when a user might be present, but temporarily withdraws his or her hand from the grasper for a short period (e.g., 0.01-0.04 seconds). In such a situation, the system may not want to halt movement of the robotic arms or surgical tools, as this may cause unnecessary interruptions, despite the presence of the user. Accordingly, in some embodiments, the system can incorporate different temporal thresholds to help refine the determination of user presence and control. For example, a first time threshold can be provided (e.g., 0.05-1 second or greater) as a debounce, whereby if a user is not detected by the system within the first time threshold, movement may be reduced or halted and/or monitored for unintended movement above a distance threshold. A second time threshold (e.g., 60 seconds, 90 seconds, 120 seconds, or greater) can be provided as a timeout, whereby if a user is not detected by the system within the second time threshold, movement may be automatically halted regardless of the distance of the unintended movement. Note that the time periods provided above for the first threshold and the second threshold are exemplary and not meant to be limiting.

In some embodiments, the additional information includes information indicating a change in the movement of robotic arms or surgical tools that is inconsistent with a user input. Such information can come from encoders (e.g., position sensors) and/or from derived information based on changes to velocity, acceleration, jerking, etc. For example, a bump or impulse in a motion profile of the robotic arms or surgical tools or information from mechatronic sensors, such as current, back electromotive force, torque, or force, could indicate movement of the robotic arms or surgical tools that are different from the movement of the robotic arms or surgical tools caused by the user input. In another example, gravity drift is detected based on the information from mechatronic sensors (e.g., an error in gravity compensation may result in a constant acceleration in a constant direction).

38 FIG.A 381 382 383 illustrates a state diagram for the medical robotic system in accordance with some embodiments. The state diagram includes a (unmodified) teleoperation mode, a modified teleoperation mode, and a safe mode.

381 381 382 In some embodiments, in accordance with a determination that user control is detected, the medical robotic system enters or remains in the (unmodified) teleoperation mode. In some embodiments, while the medical robotic system is in the (unmodified) teleoperation mode, the medical robotic system moves robotic arms and/or surgical instruments in accordance with a user input without any damping (or with a first damping that is less than a second damping provided while the medical robotic system is in the modified teleoperation mode).

383 383 383 383 In some embodiments, in the event that lack of user control is detected in conjunction with movement of the robotic arms or surgical tools, the medical robotic system can transition into the safe mode. While the medical robotic system is in the safe mode, teleoperation is halted or cut off between the input device and the robotic arm or surgical instrument. In some embodiments, to avoid unnecessary disruptions, the medical robotic system monitors the movement of the input device, and transition into the safe modeif the position of the input device has changed by an unsafe distance in comparison to when the user was last detected to be in active control. Additionally or alternatively, the medical robotic system can transition into the safe modeif the motion (velocity, acceleration, etc.) of the input device is considered unsafe (e.g., the velocity of the input device exceeds a velocity threshold or the acceleration of the user acceleration exceeds an acceleration threshold) while the user is not detected to be in active control.

383 382 In some implementations, the medical robotic system, prior to entering the safe mode, still modifies control algorithms to decrease the likelihood of hazardous unintended motion via (i) changing motion scaling so the input device motion results in smaller tool tip motion; (ii) adjusting damping on the input device to increase the load required to create input device motion; (iii) command haptic feedback to maintain a current position of the input device; and (iv) saturate commanded velocity from the input device at a lower value than during normal operation. For example, any of the foregoing (i) to (iv) can also be provided while the medical robotic system is in the modified teleoperation mode. The advantage of (i) to (iv) is that the teleoperation is not interrupted unnecessarily. For example, a situation may occur where though a user presence/control might not be detected, it may not be warranted to enter into a safe mode whereby teleoperation is halted. In such a scenario, the system can, for example, dampen the motion of the input device, instead of immediately halting teleoperation of the system.

38 FIG.A 381 382 382 383 381 383 382 383 Although the system diagram shown inincludes state transitions between the (unmodified) teleoperation modeand the modified teleoperation mode, state transitions between the modified teleoperation modeand the safe mode, and state transitions between the (unmodified) teleoperation modeand the safe mode, in some implementations, one or more state transitions may be omitted or blocked (e.g., in some implementations, state transitions between the modified teleoperation modeand the safe modemay not be allowed).

38 FIG.A 381 383 Although the system diagram shown inhas three states, in some embodiments, the system diagram may include additional or fewer states (e.g., the system diagram may have only two states, such as the (unmodified) teleoperation modeand the safe mode).

38 FIG.B illustrates transitions among different states of a medical system in accordance with some embodiments.

38 FIG.B 370 371 370 372 373 373 374 375 373 375 373 371 376 377 The states illustrated ininclude engaged stateand disengaged state. In some embodiments, the engaged stateincludes substates, such as “not driving” state, which indicates that a user is not in control, and driving state, which indicates that a user is in control. In some embodiments, the driving stateincludes also includes substates, such as “user detected” state, which indicates that a user is detected (e.g., using a capacitance sensor) and “user not detected” state(e.g., using a capacitance sensor). Thus, a user may be in control (e.g., the medical system is in the driving state) even though the user is not detected (the “user not detected” state, which is a substate of the driving state). In some embodiments, the disengaged stateincludes substates, such as “head in” stateand “head out” state.

378 372 373 372 373 379 374 375 344 384 375 374 374 344 In some embodiments, the medical system () transitions from the “not driving” stateto the driving statein accordance with a determination that a gripper is matched. In some embodiments, the medical system unlocks a haptic input device in conjunction with transitioning from the “not driving” stateto the driving state. In some embodiments, the medical system () transitions from the “user detected” stateto the “user not detected” statein accordance with a determination that user presence is not detected (e.g., no sensor has detected user presence, or less than a certain number (e.g., two, three, or four) of sensors have detected user presence and a grasper angle is greater than a first threshold angle (e.g., 30°, 40°, 45°, etc.) and the shoulder yaw axishas a rotational speed below a first threshold speed (e.g., less than 0.1 rad/s, 0.2 rad/s, 0.3 rad/s, 0.4 rad/s, 0.5 rad/s, 0.6 rad/s, 0.7 rad/s, 0.8 rad/s, 0.9 rad/s, 1 rad/s, 2 rad/s, 3 rad/s, 4 rad/s, 5 rad/s, or 10 rad/s, etc.)). In some embodiments, the medical system () transitions from the “user not detected” stateto the “user detected” statein accordance with a determination that any sensor has detected user presence. For example, the medical system may transition to the “user detected” statein accordance with a determination that a certain number of sensors (e.g., capacitance sensors), such as two or more sensors, have detected user presence, or a grasper angle is closed (e.g., less than a second threshold angle, such as 15°, 10°, 5°, etc.), or the shoulder yaw axishas a rotational speed above a second threshold speed (e.g., greater than 0.1 rad/s, 0.2 rad/s, 0.3 rad/s, 0.4 rad/s, 0.5 rad/s, 0.6 rad/s, 0.7 rad/s, 0.8 rad/s, 0.9 rad/s, 1 rad/s, 2 rad/s, 3 rad/s, 4 rad/s, 5 rad/s, or 10 rad/s, etc.).

374 375 374 385 374 375 374 386 374 375 387 375 388 375 389 371 370 376 370 In some embodiments, the medical system resets a timer (and/or restarts the timer) in conjunction with transitioning to the “user detected” state(e.g., the timer is used to determine whether the medical system should transition to the “user not detected” state). In some embodiments, the medical system, while in the “user detected” state, detects user presence (e.g., any sensor has detected user presence), and in response, () remains in the “user detected” stateand resets a timer (and/or restarts the timer) (e.g., for determining whether the medical system should transition to the “user not detected” state). In some embodiments, the medical system, while in the “user detected” state, does not detect user presence (e.g., no sensor has detected user presence), and in response, () remains in the “user detected” stateand resets a timer (and/or restarts the timer) (e.g., for determining whether the medical system should transition to the “user not detected” state). In some embodiments, the medical system () transitions from the “user not detected” stateto the “head in” state in accordance with a determination that the timer has elapsed a threshold duration (e.g., 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 30, 40, 50, or 60 seconds or within an interval between any two of the aforementioned values). In some embodiments, the medical system locks the haptic input device (e.g., stops movement of the robotic arm or the surgical tool in response to movement of the haptic input device) in conjunction with transitioning to the “head in” state. In some embodiments, the medical system () transitions from the “user not detected” stateto the “head in” state in accordance with a determination that a robotic arm or a surgical tool has drifted more than a distance threshold (e.g., 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 30, 40, 50, or 60 mm or within an interval between any two of the aforementioned values). In some embodiments, the medical system locks the haptic input device in conjunction with transitioning to the “head in” state. In some embodiments, the medical system () transitions from the disengaged stateto the engaged statein accordance with a determination that any sensor has detected user presence. In some embodiments, the medical system resets a timer (and/or restarts the timer) in conjunction with transitioning from the “head in” stateto the engaged state.

375 374 375 374 In some embodiments, the medical system resets a timer (and/or restarts the timer) in conjunction with transitioning to the “user not detected” state. In some embodiments, the timer can serve as secondary information (e.g., in addition to sensing via capacitance) to help determine when the system can properly transition back to a “user detected” state. For example, in some embodiments, when the system is in the “user not detected” state, it may take a certain amount of time before the system transitions back to the “user detected” state, even beyond the initial contact between the user and the graspers and the associated capacitance sensors.

375 374 375 374 375 375 375 375 In another embodiment, the secondary information (with or without the sensor information) is used to determine criteria for a state transition. In some embodiments, the medical system resets a timer (and/or restarts the timer) in conjunction with transitioning to the “user not detected” state. In some embodiments, the timer can serve as secondary information (e.g., in addition to sensing via capacitance) to help determine the criteria for when the system can properly transition back to a “user detected” state. For example, in some embodiments, when the system is in the “user not detected” statefor longer than a pre-defined duration (e.g., 1 second), the system may require specific criteria based on the contact sensing and/or secondary information to transition back to “user detected” state. This criteria could be different than the criteria to re-establish “user detection” if the user has not been detected for less than that duration. For example, the system may require only 1 sensor to indicate presence if the system was in “user not detected” statefor less than 1 second, and require at least 2 sensors to indicate presence if the system was in “user not detected” statefor more than 1 second. Alternatively, the system may allow secondary information such as G6 motion to indicate presence if the system was in “user not detected” statefor less than 1 second, but require contact sensors to indicate presence if the system was in “user not detected” statefor more than 1 second. Providing a timer as secondary information in the “user not detected” state can advantageously help determine what criteria from the information warrants the transition back to “user detected”.

371 376 370 373 374 371 376 370 373 374 373 371 In some embodiments, the medical system resets a timer (and/or restarts the timer) in conjunction with transitioning to the disengaged state(e.g., “head in” state). In some embodiments, the timer can serve as secondary information (e.g., in addition to sensing via capacitance) to help determine when the system can properly transition back to the engaged state(e.g., the driving state, and in particular the “user detected” state). For example, in some embodiments, when the system is in the disengaged state(e.g., “head in” state), it may take a certain amount of time before the system transitions back to the engaged state(e.g., the driving state, and in particular “user detected” state), even beyond the initial contact between the user and the graspers and the associated capacitance sensors. This is because the system may want to account for the initial touch by the user with the grasper pads prior to actual teleoperated driving. In other words, the system may not want to go straight to the driving stateupon the user's initial contact with the graspers. Providing a timer as secondary information in the disengaged statecan advantageously help determine whether a user's contact has been made with the graspers long enough to warrant actual driving. In some embodiments, the medical system resets the timer (and/or restarts the timer) in response to detecting the user presence (so that a certain period of time (e.g., 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, or 1 second) after the user presence has been detected can elapse before allowing the user to drive the robotic arm).

371 376 370 373 374 371 370 373 374 371 371 344 371 371 371 370 373 374 In some embodiments, the medical system resets a timer (and/or restarts the timer) in conjunction with transitioning to the disengaged state(e.g., “head in” state). In some embodiments, the timer can serve as secondary information (e.g., in addition to sensing via capacitance) to help determine the criteria for when the system can properly transition back to a the engaged state(e.g., the driving state, and in particular the “user detected” state). For example, in some embodiments, when the system is in the disengaged statefor longer than a pre-defined duration (e.g., 1 second), the system may require specific criteria based on the contact sensing and/or secondary information to transition back to the engaged state(e.g., the driving state, and in particular the “user detected” state). This criteria could be different than the criteria to re-establish “user detection” if the user has not been detected for less than the pre-defined duration. For example, the system may require only 1 sensor to indicate presence if the system was in the disengaged statefor less than 1 second, and require at least 2 sensors to indicate presence if the system was in the disengaged statefor more than 1 second. Alternatively, the system may allow secondary information such as a rotational movement (or a rotational velocity) of a rotational joint extending through the shoulder yaw axisto indicate user presence if the system was in the disengaged statefor less than 1 second, but also require contact sensors to indicate user presence if the system was in the disengaged statefor more than 1 second. Providing a timer as secondary information in the disengaged statecan advantageously help determine what criteria from the information warrants the transition back to the engaged state(e.g., the driving state, and in particular, the “user detected” state) and actual driving.

344 In some embodiments, the secondary information includes an end effector pose or information indicating a change in the end effector pose. For example, in some embodiments, the secondary information includes (i) the end effector pose or the information indicating a change in the end effector pose, and (ii)_a rotational movement (or a rotational velocity) of a rotational joint extending through the shoulder yaw axisso that the user control is determined based on the change in the end effector pose and the rotational movement, even when no user contact is detected (e.g., using a capacitance sensor). In some embodiments, the change in the end effector pose is used to select the criteria for the state transition. For example, in accordance with a determination that a movement, of the end effector, that is associated with user control (e.g., continuous or semi-continuous movement of the end effector, movement of the end effector at a speed below a threshold speed, movement of the end effector that includes a change in a direction of the end effector) is detected, first criteria (e.g., less stringent criteria, such as requiring detection of contact by a single sensor) are used for a state transition. In accordance with a determination that a movement, of the end effector, that is not associated with user control (e.g., gravity drift or bump), second criteria (e.g., more stringent criteria, such as requiring detection of contact by multiple sensors) are used for a state transition.

39 39 FIGS.A andB 21 FIG. 400 are a flowchart illustrating a methodfor operating a surgical tool via the input device of.

400 4010 311 1 311 2 The methodincludes, while operating a robotic arm in response to information from an input device, () receiving first information from a first set of two or more electrodes (e.g., electrodes-and-).

400 4020 328 301 30 30 FIGS.B andC In some embodiments, the methodalso includes () determining, by an integrated circuit (e.g., integrated circuit), a mutual capacitance between the two or more electrodes of the first set of two or more electrodes (e.g., the integrated circuit includes circuitelectrically coupled to the electrode as shown in). The user presence is determined based at least in part on the mutual capacitance (e.g., a change in the mutual capacitance, above a threshold value, indicates the user presence).

400 4030 400 4040 400 The methodalso includes () determining a user presence at a first finger pad based on the first information. The first finger pad includes the first set of two or more electrodes. The methodfurther includes () modifying operation (e.g., teleoperation) of the robotic arm in response to the information from the input device in accordance with a determination of the user presence at the first finger pad. In some embodiments, the methodfurther includes modifying operation (e.g., teleoperation) of the robotic arm in response to the information from the input device in accordance with a determination of lack of the user presence at the first finger pad.

4042 In some embodiments, modifying teleoperation of the robotic arm includes () ceasing movement of the robotic arm in response to the information from the input device (e.g., regardless of any input provided to the input device the robotic arm may not move).

4044 In some embodiments, modifying teleoperation of the robotic arm includes () reducing a velocity of the robotic arm in response to the information from the input device (e.g., the robotic arm moves at a first velocity before the modification, and the robotic arm moves at a second velocity less than the first velocity after the modification).

4046 In some embodiments, modifying teleoperation of the robotic arm includes () reducing motion scaling between the input device and the robotic arm. (e.g., reducing an amount of movement of the robotic arm with respect to an amount of movement of the input device). For example, the robotic arm may move by a first distance in response to movement of an input device by a particular input distance before the modification and the robotic arm may move by a second distance less than the first distance in response to movement of the input device by the particular input distance after the modification.

400 4050 4052 In some embodiments, the methodalso includes () receiving second information from a second set of two or more electrodes, and () determining a user presence at a second finger pad based at least in part on the second information. The second finger pad includes the second set of two or more electrodes.

400 4054 4056 400 4058 4060 In some embodiments, the methodalso includes () receiving third information from a third set of two or more electrodes, and () determining a user presence at a third finger pad based at least in part on the third information. The third finger pad includes the third set of two or more electrodes. The methodfurther includes () receiving fourth information from a fourth set of two or more electrodes, and () determining a user presence at a fourth finger pad based on the fourth information. The fourth finger pad includes the fourth set of two or more electrodes.

400 4070 400 400 400 400 400 In some embodiments, the methodalso includes () modifying the operation of the robotic arm in response to the information from the input device in accordance with a determination of the user presence at the second finger pad. In some embodiments, the methodalso includes modifying the operation of the robotic arm in response to the information from the input device in accordance with a determination of lack of the user presence at the second finger pad. In some embodiments, the methodincludes modifying the operation of the robotic arm in response to the information from the input device in accordance with a determination of the user presence at the first finger pad and the user presence at the second finger pad. In some embodiments, the methodincludes modifying the operation of the robotic arm in response to the information from the input device in accordance with a determination of lack of the user presence at the first finger pad and lack of the user presence at the second finger pad. In some embodiments, the methodincludes modifying the operation of the robotic arm in response to the information from the input device in accordance with a determination of the user presence at the first finger pad, the user presence at the second finger pad, and the user presence at the third finger pad. In some embodiments, the methodincludes modifying the operation of the robotic arm in response to the information from the input device in accordance with a determination of the user presence at the first finger pad, the user presence at the second finger pad, the user presence at the third finger pad, and the user presence at the fourth finger pad.

400 182 200 311 1 311 2 280 383 381 282 In some embodiments, the methodis performed by a medical system that includes an input device (e.g., the input system) for controlling (e.g., movement, function) operation (e.g., teleoperation) of a robotic arm. The input device includes a grasper (e.g., the grasper) that includes a first finger pad. The first finger pad includes a first set of two or more electrodes (e.g., electrodes-and-) for determining a user presence at the first finger pad (e.g., user proximity to the first finger pad, or user contact with the first finger pad). The medical system also includes a processor (e.g., processor(s)) for modifying operation of the robotic arm in response to information (e.g., one or more electrical signals corresponding to a user input) from the input device in accordance with a determination of the user presence at the first finger pad (e.g., transition the medical system into a safe mode (e.g., safe mode) in accordance with (based at least in part on) a determination that the user is not present at the first finger pad, and transitioning the medical system out of the safe mode (e.g., to the teleoperation mode) in accordance with (based at least in part on) a determination that the user is present at the first finger pad). In some embodiments, the medical system also includes memory (e.g., memory) storing instructions for execution by the processor. The stored instructions include instructions for modifying the operation of the robotic arm in response to the information from the input device in accordance with the determination of the user presence at the first finger pad.

In some embodiments, the two or more electrodes include a first electrode and a second electrode that is interdigitated (e.g., coiled) with the first electrode.

In some embodiments, the two or more electrodes include a first electrode and a second electrode that is disposed adjacent to the first electrode. In some embodiments, the first electrode and the second electrode extend substantially in a same direction.

In some embodiments, the grasper includes a second finger pad distinct and separate from the first finger pad. The second finger pad includes a second set of two or more electrodes for determining a user presence (e.g., user proximity to the finger pad) at the second finger pad. The user presence at the second finger pad is determined independently of the user presence at the first finger pad.

In some embodiments, the grasper further includes a third finger pad and a fourth finger pad. In some embodiments, the grasper includes additional finger pads (e.g., a fifth finger pad, a sixth finger pad, etc.).

In some embodiments, the third finger pad includes a third set of two or more electrodes for determining a user presence (e.g., user proximity to the finger pad) at the third finger pad, and the fourth finger pad includes a fourth set of two or more electrodes for determining a user presence (e.g., user proximity to the finger pad) at the fourth finger pad. The user presence at the first finger pad, the user presence at the second finger pad, the user presence at the third finger pad, and the user presence at the fourth finger pad are determined independently of each other.

In some embodiments, in accordance with a determination of a lack of the user presence (e.g., user is not proximate to the finger pad or user is not in contact with any of the finger pads, all of the finger pads, or a predefined number of finger pads), the processor ceases operation (e.g., teleoperation, movement) of the robotic arm in response to the information from the input device. In some embodiments, the memory stores instructions for execution by the processor, the stored instructions including instructions for, in accordance with the determination of the lack of the user presence, ceasing the operation of the robotic arm in response to the information from the input device.

In some embodiments, in accordance with a determination of a lack of the user presence (e.g., user is not proximate to the finger pad or user is not in contact with any of the finger pads, all of the finger pads, or a predefined number of finger pads), the processor reduces a velocity of the robotic arm in response to the information from the input device. In some embodiments, the memory stores instructions for execution by the processor, the stored instructions including instructions for, in accordance with the determination of the lack of the user presence, reducing the velocity of the robotic arm in response to the information from the input device.

In some embodiments, in accordance with a determination of a lack of the user presence (e.g., user is not proximate to the finger pad or user is not in contact with any of the finger pads, all of the finger pads, or a predefined number of finger pads), the processor reduces motion scaling between the input device and the robotic arm (e.g., reducing an amount of movement of the robotic arm with respect to an amount of movement of the input device). In some embodiments, the memory stores instructions for execution by the processor, the stored instructions including instructions for, in accordance with the determination of the lack of the user presence, reducing the motion scaling between the information from the input device and the movement of the robotic arm.

In some embodiments, the grasper further includes an integrated circuit for measuring a mutual capacitance between the two or more electrodes of the first set of two or more electrodes. The user presence is determined based at least in part on the mutual capacitance.

In some embodiments, the grasper includes a static handle that is coupled to the first finger pad, the first finger pad configured to move relative to the static handle. The integrated circuit is disposed in the static handle.

In some embodiments, the first set of two or more electrodes is embedded within the first finger pad.

In some embodiments, the first set of two or more electrodes includes an electrode layer comprising the two or more electrodes; and a shield layer for reducing capacitance between the two or more electrodes with components of the grasper.

40 FIG. 21 FIG. 410 is a flowchart illustrating a methodof operating a medical system for controlling a medical instrument using the input device of.

410 4110 4120 4130 The methodincludes () receiving, from a sensor coupled to (e.g., embedded in) a grasper of the input device, sensor information related to a user presence at the grasper; () receiving secondary information associated with the grasper (e.g., a configuration of the grasper, such as grasper angle or velocity, motion of a passively stationary joint, and/or a time point of last grasper movement or last-detected user presence); and () determining user control at the grasper based on the sensor information and the secondary information. As used herein, in some cases, the term “user control” refers to an input intentionally (or deliberately) provided a user for controlling movement of a robotic arm, as compared to an input unintentionally provided by the user (e.g., due a slip of a finger, slow drift, etc.).

4132 In some embodiments, the secondary information includes a time threshold. Determining the user presence at the grasper includes () comparing duration over which the sensor information indicates a lack of the user presence and the time threshold.

4134 In some embodiments, the secondary information includes information indicating a change in a configuration (e.g., position and/or orientation) of the input device at a first time and a second time that is subsequent to the first time (e.g., current time). Determining the user presence at the grasper includes () comparing the change in the configuration of the input device and a configuration change threshold (e.g., a predefined distance and/or angle difference).

In some embodiments, the information indicating the change in the configuration of the input device is obtained by determining a configuration (e.g., a position and/or orientation) of the input device at the first time, determining a configuration of the input device at the second time, and determining the change in the configuration of the input device based on the configuration of the input device at the first time and the configuration of the input device at the second time.

4136 In some embodiments, the secondary information includes information indicating a change in a configuration (e.g., position and/or orientation) of the medical instrument at a first time and a second time that is subsequent to the first time (e.g., current time). Determining the user presence at the grasper includes () comparing the change in the configuration of the medical instrument and a configuration change threshold (e.g., a predefined distance and/or angle difference).

In some embodiments, the information indicating the change in the configuration of the medical instrument is obtained by determining a configuration (e.g., a position and/or orientation) of the medical instrument at the first time, determining a configuration of the medical instrument at the second time, and determining the change in the configuration of the medical instrument based on the configuration of the medical instrument at the first time and the configuration of the medical instrument at the second time.

410 182 200 328 In some embodiments, the methodis performed by a medical system that includes an input device (e.g., the input system) for controlling (e.g., movement, function) operation (e.g., teleoperation) of a robotic arm. The input device includes a grasper (e.g., the grasper) that includes a first finger pad. The first finger pad includes a first set of two or more electrodes. The medical system also includes an integrated circuit (e.g., the integrated circuit) for measuring a mutual capacitance between the two or more electrodes of the first set of two or more electrodes for determining a user presence at the first finger pad (e.g., user proximity to the first finger pad, or user contact with the first finger pad).

41 FIG. 21 FIG. 420 is a flowchart illustrating a methodof operating a medical system that includes the input device of.

420 4210 4220 4230 4240 The methodincludes () receiving, from a sensor coupled to (e.g., embedded in) a grasper of the input device, sensor information related to a user presence at the grasper; () receiving secondary information from the input device; (e.g., a configuration of the grasper, such as grasper angle or velocity, and/or a time point of last grasper movement or last-detected user presence); () determining whether a user is in control of the input device based on the sensor information and the secondary information (e.g., although a capacitance sensor can detect lack of user presence, this alone is not sufficient to transition into a safe mode-instead, transition to the safe mode may not be triggered until a certain amount of time has passed or a certain drift distance has been detected. This helps reducing disruptions by cutting off teleoperation. If neither of these criteria is met, then the system can enter a “modified teleoperation” mode by, for example, changing motion scaling of the teleoperation, damping the input device, etc.); and () in accordance with a determination that the user is not in control of the input device, transitioning the medical system into a safe mode.

4202 In some embodiments, the robotic arm is coupled to a medical instrument comprising a tool tip. Prior to transitioning the medical system into the safe mode, the medical system operates () in a modified teleoperation mode whereby motion scaling between the input device and the medical instrument is changed such that movement of the tool tip in response to movement of the grasper is reduced. Such modified teleoperation mode allows a user to stay in uninterrupted teleoperation, but reduces likelihood of the user losing control when the user is transiently not in contact with the grasper (or the capacitance sensors).

4204 In some embodiments, prior to transitioning the medical system into the safe mode, the damping of the robotic arm is adjusted () in response to information from the input device.

4206 In some embodiments, prior to transitioning the medical system into the safe mode, haptic feedback is provided () to a user (e.g., via the grasper) to maintain a position of the input device.

4242 In some embodiments, transitioning the medical system into the safe mode includes () halting operation of the robotic arm in response to information from the input device.

420 In some embodiments, the methodalso includes transitioning the medical system into an (unmodified) teleoperation mode in accordance with a determination that the user is in control of the input device.

420 4250 In some embodiments, the methodfurther includes () transitioning the medical system out of the safe mode (e.g., transitioning the medical system into the (unmodified) teleoperation mode or the modified teleoperation mode) based on the sensor information and the secondary information. The second information includes information indicating a duration of time the medical system has been in the safe mode. For example, the medical system may wait for a certain period of time after user presence has been detected (e.g., using a capacitance sensor) before moving a robotic joint in accordance with user input. This reduces or eliminates movement of a robotic joint due to an inadvertent contact.

420 In some embodiments, the methodfurther includes transitioning the medical system out of the modified teleoperation mode (e.g., transitioning the medical system into the (unmodified) teleoperation mode) based on the sensor information and the secondary information. The second information includes information indicating a duration of time the medical system has been in the safe mode.

420 4260 In some embodiments, the methodfurther includes, () when the medical system has been in the safe mode for a duration of time less than a predefined threshold, transitioning the medical system out of the safe mode (e.g., transitioning the medical system into the (unmodified) teleoperation mode or the modified teleoperation mode) based on first criteria; and when the medical system has been in the safe mode for a duration of time longer than the predefined threshold, transitioning the medical system out of the safe mode (e.g., transitioning the medical system into the (unmodified) teleoperation mode or the modified teleoperation mode) based on second criteria distinct from the first criteria. For example, the medical system may transition out of the safe mode in response to detecting user presence on one sensor if the medical system has been in the safe mode for a duration of time less than the predefined threshold (e.g., one second), but may require detecting the user presence on two or more sensors if the medical system has been in the safe mode for a duration of time greater than the predefined threshold, before transitioning out of the safe mode.

420 In some embodiments, the methodfurther includes, when the medical system has been in the modified teleoperation mode for a duration of time less than a predefined threshold, transitioning the medical system out of the modified teleoperation mode (e.g., transitioning the medical system into the (unmodified) teleoperation mode) based on third criteria; and when the medical system has been in the modified teleoperation mode for a duration of time longer than the predefined threshold, transitioning the medical system out of the modified teleoperation mode (e.g., transitioning the medical system into the (unmodified) teleoperation mode) based on fourth criteria distinct from the third criteria.

420 183 200 280 282 In some embodiments, the methodis performed by a medical system that includes an input device (e.g., the input system) for controlling a medical instrument (e.g., surgical tool). The input device includes a grasper (e.g., the grasper) for receiving user input; and a sensor (e.g., one or more capacitance sensors) coupled to the grasper for generating sensor information related to a user presence at the grasper. The medical system also includes a processor (e.g., processor(s)) and memory (e.g., computer readable storage medium) storing instructions for execution by the processor. The stored instructions include instructions for receiving secondary information associated with the grasper (e.g., a configuration of the grasper, such as grasper angle or velocity, and/or a time point of last grasper movement or last-detected user presence) and determining user control at the grasper based on the sensor information and the secondary information.

In some embodiments, the sensor comprises any of a capacitance-based sensor or a light-based sensor.

In some embodiments, the grasper includes a finger pad forming a grasper angle with respect to a reference axis of the grasper, the finger pad being moveable relative to the reference axis. The secondary information includes the grasper angle.

In some embodiments, the input device includes a joint. The secondary information includes a position and/or velocity of the joint.

In some embodiments, the joint comprises a passively stationary joint of the input device.

In some embodiments, the joint comprises a roll joint of the input device.

In some embodiments, the secondary information includes a time threshold for comparison with a duration over which the sensor detects a lack of a user presence.

In some embodiments, the memory also stores instructions for determining the user presence based in part on a comparison of a duration over which the sensor does not detect the user presence and a time threshold.

In some embodiments, the secondary information includes information indicating a change in a configuration (e.g., position and/or orientation) of the input device at a first time and a second time that is subsequent to the first time (e.g., current time).

In some embodiments, the memory also stores instructions for determining the user presence based in part on a comparison of the configuration of the input device at the first time and a configuration of the input device at the second time. In some embodiments, the first time corresponds to a time point when the user presence was detected.

In some embodiments, the secondary information includes information indicating a change in a configuration (e.g., position and/or orientation) of the medical instrument at a first time and a second time that is subsequent to the first time (e.g., current time).

In some embodiments, the memory also stores instructions for determining the user presence based in part on a comparison of the configuration of the medical instrument at the first time and a configuration of the medical instrument at the second time. In some embodiments, the first time corresponds to a time point when the user presence was detected.

42 FIG. 21 FIG.A is a schematic diagram illustrating electronic components of a medical system that includes the input device of.

280 282 280 284 284 286 182 200 287 286 280 287 328 328 280 284 280 292 1 292 2 284 290 290 292 290 284 284 292 290 33 39 39 40 41 FIGS.,A-B,, and 39 FIG. The robotic medical system includes one or more processors, which are in communication with a computer readable storage medium(e.g., computer memory devices, such as random-access memory, read-only memory, static random-access memory, and non-volatile memory, and other storage devices, such as a hard drive, an optical disk, a magnetic tape recording, or any combination thereof) storing instructions for performing any methods described herein (e.g., operations described with respect to). The one or more processorsare also in communication with an input/output controller(via a system bus or any suitable electrical circuit). The input/output controllerreceives user input from input device(e.g., the input system, or in particular, the grasper) and sensor data from one or more sensors (e.g., sensors, such as capacitance sensors, optical sensors, grasper angle sensor, etc. as described herein, which are coupled to the input device), and relays the sensor data to the one or more processors. In some embodiments, the sensorsinclude the integrated circuit. In some embodiments, the integrated circuitis integrated with the one or more processors(or vice versa). The input/output controlleralso receives instructions and/or data from the one or more processorsand relays the instructions and/or data to one or more actuators, such as first motors-and-, etc. In some embodiments, the input/output controlleris coupled to one or more actuator controllersand provides instructions and/or data to at least a subset of the one or more actuator controllers, which, in turn, provide control signals to selected actuators. In some embodiments, the one or more actuator controllerare integrated with the input/output controllerand the input/output controllerprovides control signals directly to the one or more actuators(without a separate actuator controller). Althoughshows that there is one actuator controller(e.g., one actuator controller for the entire medical platform, in some embodiments, additional actuator controllers may be used (e.g., one actuator controller for each actuator, etc.).

It should be noted that the terms “couple,” “coupling,” “coupled” or other variations of the word couple as used herein may indicate either an indirect connection or a direct connection. For example, if a first component is “coupled” to a second component, the first component may be either indirectly connected to the second component via another component or directly connected to the second component.

The term “computer-readable medium” refers to any available medium that can be accessed by a computer or processor. By way of example, and not limitation, such a medium may comprise random access memory (RAM), read-only memory (ROM), electrically erasable programmable read-only memory (EEPROM), flash memory, compact disc read-only memory (CD-ROM) or other optical disk storage, magnetic disk storage or other magnetic storage devices, or any other medium that can be used to store desired program code in the form of instructions or data structures and that can be accessed by a computer. It should be noted that a computer-readable medium may be tangible and non-transitory. As used herein, the term “code” may refer to software, instructions, code or data that is/are executable by a computing device or processor.

The methods disclosed herein comprise one or more steps or actions for achieving the described method. The method steps and/or actions may be interchanged with one another without departing from the scope of the claims. In other words, unless a specific order of steps or actions is required for proper operation of the method that is being described, the order and/or use of specific steps and/or actions may be modified without departing from the scope of the claims.

As used herein, the term “plurality” denotes two or more. For example, a plurality of components indicates two or more components. The term “determining” encompasses a wide variety of actions and, therefore, “determining” can include calculating, computing, processing, deriving, investigating, looking up (e.g., looking up in a table, a database or another data structure), ascertaining and the like. Also, “determining” can include receiving (e.g., receiving information), accessing (e.g., accessing data in a memory) and the like. Also, “determining” can include resolving, selecting, choosing, establishing and the like.

The phrase “based on” does not mean “based only on,” unless expressly specified otherwise. In other words, the phrase “based on” describes both “based only on” and “based at least on.”

The previous description of the disclosed implementations is provided to enable any person skilled in the art to make or use the present invention. Various modifications to these implementations will be readily apparent to those skilled in the art, and the generic principles defined herein may be applied to other implementations without departing from the scope of the invention. For example, it will be appreciated that one of ordinary skill in the art will be able to employ a number corresponding alternative and equivalent structural details, such as equivalent ways of fastening, mounting, coupling, or engaging tool components, equivalent mechanisms for producing particular actuation motions, and equivalent mechanisms for delivering electrical energy. Thus, the present invention is not intended to be limited to the implementations shown herein but is to be accorded the widest scope consistent with the principles and novel features disclosed herein.